Becker's Speaker Series: 4 questions with Novant Health Director of RCS Utilization Review, Nathan Hughes

Nathan Hughes serves as Director of RCS Utilization Review for Novant Health.

On Thursday, September 21 and Friday, September 22, Nathan Hughes will speak on a panel at Becker's Hospital Review 3rd Annual Health IT + Revenue Cycle Conference. As part of an ongoing series, Becker's is talking to healthcare leaders who plan to speak at the conference, which will take place September 21 through September 23 in Chicago.

To learn more about the conference and Nathan's session, click here.

Question: Please share the state of revenue cycle management at your organization. What is your payer mix? What about your revenue cycle is working well, what needs improvement and what do you find yourself spending more time on?

hughes Nathan Headshot

Nathan Hughes: The overall state of our revenue cycle is extremely healthy and stable at this time. We have seen consistent improvement over the past several years in many of our key performance indicators. Many of our metrics are within the top quartile compared to organizations of similar size and complexity. Like many organizations, our biggest area of opportunity is denial prevention. Our write-offs as a percentage of gross revenue are in line with the industry standard, but there is still significant opportunity for improvement. We are implementing a new denial reporting tool later this year that will accompany new strategies aimed at reducing denials.

We are also focused on IT optimization. We spend a great deal of time partnering with our IT department to prioritize system upgrades, functionality enhancements and business intelligence development. The human experience has been a primary focus for us the last several years. We have engaged patients and team members to better understand how we can improve the patient financial experience. We have also developed a future state vision of "what if..." statements and identified short-, medium- and long-term tactical strategies to achieve the vision our patients desire.

Q: How have alternative payment models affected your line of work? Can you share three specific steps, if any, has your organization taken to adapt to bundles and ACO payments?

NH: Our organization is participating in several bundled payments with governmental and commercial payers. The revenue cycle team has been involved in many facets of the bundled payment discussions. We have interdisciplinary teams that closely monitor outcomes of specific KPIs that ultimately determine our financial outcomes. Several revenue cycle departments are involved in those discussions with clinical departments and other financial leaders.

Q: Percent-wise, roughly how much of your revenue cycle is automated? Do you plan to maintain that percent or increase in the next one to two years? What effects have you seen from automation, good or bad?

NH: We’ve certainly automated some aspects of our revenue cycle, although I couldn’t assign a specific percentage to it. We are currently implementing new tools in several of our departments that will increase automation this year. A couple examples are automated claim status checks and enhanced insurance eligibility checks for self-pay patients. Automation can obviously improve efficiency and quality if the proper rules and quality control checks are put into place. However, without some form of quality control, automation can be dangerous. We also have to be careful that the patient-facing components of our revenue cycle are not automated to the point we lack any sense of a human touch. Our patients expect efficient, seamless interactions that utilize technology and a personal connection throughout their experience with us.

Q: What is one investment you've made in RCM that has surprised you in terms of ROI? How so?

NH: Our revenue cycle leaders have been committed to team member engagement for several years.
As a result, we have seen steady increases in our team member engagement scores, and turnover has decreased by 13 percent compared to prior years. We also implemented several new, highly lucrative incentive plans for team members that impact fatal denials and/or cash collections. We knew the ROI would be strong, but the teams have far exceeded our initial expectations when the programs were introduced last year. For example, the ROI for the incentive plan to reduce medical necessity denials was 600 percent.

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