This article is part two of a three-part blog series with Scott Mendenhall. Scott Mendenhall is an experienced revenue cycle professional with twenty-five years of healthcare experience.

In the 20+ years you’ve been working with healthcare organizations on revenue cycle improvement, what trends have you noticed?

In almost every review I’ve done, I’ve seen organizations struggle when it comes to scheduling and patient access. One of the problems in hospitals and physician practices is that the staff working at the front desk typically have some of the lowest salaries in the organization and often the least amount of training. We’re requiring them to be very meticulous and do quality work when we’re not paying them very much. That’s a consistent problem that I see in every organization. As a result, I see consistent problems when it comes to the medical records and coding these claims. The documentation is so poor that the coders who code the claims don’t have proper documentation from clinicians or physicians to actually select the right code. They’ll often select a code that is lower in reimbursement than the one they probably could have selected if they’d had the documentation. Based on these two issues alone, everyone seems to have a problem with denials. Denials occur when the insurance companies, Medicare, Medicaid refuse a claim because they may not have the patient in their database. This occurs because the registration staff selected the wrong person. This delays payment because those denials from the insurance company have to be rebilled which adds even further time until they get paid, if they get paid. There are many common threads I’ve seen over these years and there have been some improvements, especially in the big healthcare systems. But smaller organizations don’t have the same funds when it comes to technology that could help prevent these errors that are occurring up front in the first place.

We rely on the front end staff to get everything right, yet we treat them poorly and pay them the least. I’ve talked to these people about their job training, how they’re measured, and what performance metrics they get back from their manager. Oftentimes they’ll say they get little feedback. They don’t know what they need to improve unless management can provide them with that feedback. One thing I frequently recommend is allowing us to provide the front end staff with recommendations on ways they can improve their performance and strengthen the front end.

We’ve seen a rise in self pay patients, even under the Affordable Care Act. We’ve seen an increase in patients with insurance, but we still have a large percentage without it. Those problems still exist even though we have made some major headway. Any uncertainty (especially with the ACA) or threat of change puts hospitals in a crisis mode. They’re used to how things have been working under ACA, so when there’s a threat that things are going to change, hospitals hold onto every little penny they can. Then, when it comes to consulting or technology improvements, they have to be extremely cost-conscious.

As hospitals become more and more cost-conscious, they run the risk of sacrificing quality of care. If they don’t have the proper technology or are laying off nurses and other staff members, then the quality of care they provide will suffer. When quality of care decreases, it affects the revenue cycle and financial decision-making again. Readmissions are happening at an alarming rate because patients are discharged too early and end up coming back, costing even more money.

At Truitt Health, we can help hospitals get the most out of their budget by doing a full revenue cycle review and assessing, prioritizing, and implementing changes.

[Look for the final part of this three-part blog series next week!]