Revenue Cycle Management in the Age of COVID, AI, and Cyberattacks

Can you tell our readers a little about your background?

I’ve been in revenue cycle for over 22 years and have been at Chartis for a little over seven years. I’m a senior partner at Chartis and I co-lead our revenue cycle transformation practice. We work with a lot of our clients, including the provider ecosystem, on optimizing revenue cycle processes. We also coordinate with our peers and fellow practices around broader financial performance improvement, folks that work in our IT and digital practice and our supply chain.

What does revenue cycle management look like today, four years into the COVID-19 pandemic?

I think the biggest change we saw right when the pandemic hit was the move to a remote workforce. When we would do our work before, we would travel to client sites, and they would have their revenue cycle operations exclusively on site. Maybe some operations were remote. During the height of the pandemic, many of our clients had to go remote, and I think some have stayed in that model. That was probably the biggest shift: you no longer could walk the floors and see what your staff is doing. We had to ask what the investment was in our tools, technology, and infrastructure to support that remote ecosystem and making sure the work is still getting done in a timely way.

What unique challenges did COVID pose?

During the start of the pandemic, when organizations were canceling or postponing elective procedures and we saw a decline in volume, you had a lot of people that may not be having to go process and work all the accounts that they’re used to seeing. Revenue cycle’s largely a volume-driven function, so the question became, how do you shift and pivot and get folks working on things that are supporting what’s happening. We began to pivot our resources to areas that are not necessarily core rev cycle issues, but just leaning into the health system or organization to drive values. Human resource coordination was another one of the key things in the pivot, and then we needed to prepare ourselves as things scaled back up to get back into the normal course of business.

There was an increase in virtual visits, so there was a lot of work done to set up organizations to be able to build and successfully build claims out and capture the information, both from a technology and an operational standpoint.

How do supply chain disruptions, especially those driven by cyberattacks and ransomware, affect revenue cycle management? How is the industry protecting itself?

Supply chain disruptions increase costs and put more pressure on the revenue cycle to be more efficient. You have to ensure that you’re collecting every expected dollar now, thinking about revenue leakage and revenue capture, whereas you may have had a little bit of latitude before. There’s a need for increased rigor no matter what we’re billing. You want to keep the revenue performing as high as possible to mitigate some of those cost impacts.

The Change Healthcare attack from earlier this year, and some more [cyberattacks] that have been in the media around provider organizations, impact things. They make it so providers are unable to get claims out the door, creating a backlog of claims that need to be billed. It forces that same rigor on things that were working well to ensure that they’re still being done. In revenue cycle, we also need to look at service vendors and outsourcers to ensure that their security protocols are right. You need to balance the immediate need you have for that service or technology with your comfort that the vendor you’re contracting with meets all the security requirements.

What sorts of things do you look for initially to help you make an informed decision on which vendors to work with when it comes to cybersecurity?

You look at a bunch of different variables, including where their operations are based and what their protocols are. If you’re a buyer as a provider organization, you’re also pressure testing by looking at the reference checks and how complex their implementation is. You also want to hear from actual existing clients who have gone through it, perhaps more recently than someone who’s an established party.

The threat and increase of cyberattacks has organizations thinking about risk mitigation strategies. The question becomes if you want to put all your eggs in one basket with a certain function to one vendor, or if you want to split it over two – basically, asking if you’d rather have some redundancy or a backup, which can be costlier. But the impact of not having claims go out the door and cash coming in can be catastrophic. At the same time, if something happens with the one party you contract with from a cyber standpoint, you’re now at the mercy of their mitigation strategy versus having a bit of your own to be flexible with.

What impact is artificial intelligence (AI) having on rev cycle?

There’s a lot of interest from a revenue cycle standpoint in this industry; it’s been talked about for years. There have been vendors that have tried to be out front and have had some missteps. You need to ask yourself what the problem is you’re trying to solve, or the concrete use case that you’re going to apply it to, and then ask what the tangible ROI [return on investment] and benefit is. You’re not seeing it as broadly as just “you can buy an AI platform and it will automate and do all these things for your rev cycle.” You have to get more discrete with it than juts buying something, turning it on, and hoping it fixes lots of problems. It’s not an instantaneous fix; these solutions have to grow by having more data behind them for them to become more accurate and applicable.

What do you see as important next steps for the rev cycle industry?

A lot of providers out there have made large investments in technology, whether it’s their main core system or additional solutions. Asking yourself how to maximize what you’ve invested in first versus looking outside and trying to procure something new is important, or really pressure testing the core ecosystem you have and making sure you’ve maximized the functionality, the setup, the adoption, and the engagement.

Any more thoughts you’d like to share with our readers?

Better engagement between providers and payers can naturally reduce costs on both sides and make things a little bit easier; I think there’s a lot of opportunity there. You’re seeing some of that happening in the industry, and I think if that can continue, it’s a win for everyone, specifically patients and those receiving care. But the benefits are also there for providers and payers.