HFMA 2023: Worried about claim denials, recession imminent

Executives at the Association for Health Financial Management conference have expressed grave concern that economic conditions are worsening, the number of denials of health insurance claims is growing, and the complexity of in managing multiple suppliers is hindering the prospects of the hospital industry.

Health system CFOs and others focused on money issues gathered at the four-day event in Nashville, Tennessee, to share insights into those challenges and on the potential of new payment models and technologies to drive business.

Request to refuse

The top issue for health system finance leaders is Why do insurance companies deny claims?.

Covenant health, an integrated health system based in Knoxville, Tennessee, is building a tool to track denials and identify trends in insurance companies’ health policies. This will allow the company to optimize patient records and encrypt returns to reduce rejection rates, said Bob Stearnes, director of patient accounting.

new health, a nonprofit system based in Winston-Salem, North Carolina, uses ChatGPT to analyze insurance rules and compare them to accounts receivable. April York, vice president of patient financial services and revenue cycle innovation, says the process, combined with medical record analysis, helps the company identify areas where it is working. lack of reimbursement and determine the cause. The tool also helps clinicians handle claims and claims more efficiently, and the health system improves coding and wins more appeals, she said.

Supplier management

As health care organizations continue to rely heavily on suppliers For technology, social services and administration, financial executives are centralizing and streamlining operations and contractual relationships to reduce costs.

Vanderbilt University Medical Center in Nashville hired a contractor to manage its suppliers because they lacked the infrastructure to evaluate the outsourcing productivity. As a result, the teaching hospital is overspending, said Heather Dunn, vice president and director of revenue cycles. By outsourcing supplier management and contract negotiations, Vanderbilt is better able to track return on investment, she said.

Similar, NorthShore-Edward-Elmhurst Health Gregory Arnold, senior vice president of systems revenue cycles, said in Illinois there was a focus on supplier management as it expanded, resulting in significant savings and quality improvements.

Evanston’s NorthShore University Health System and Naperville-based Edward-Elmhurst Health merged last year to create a chain with more than $5 billion in annual revenue. The company has a single team that oversees supplier relationships, Arnold said, allowing leaders to leverage the scale of the health system for better pricing and tracking progress internally.

Depression anxiety

Amid economic uncertainty, health system finance executives say they are Prepare as best you can for what lies ahead.

Health Care HCA Chief financial officer William Rutherford said the Nashville-based for-profit health system has hired consultants to study how previous recessions have affected business. Leaders are looking at how HCA and other companies successfully responded to economic challenges in the past to inform how the company can navigate the economic downturn. HCA conducted similar activities in 2019 related to major policy reform proposals, including the possibility of repealing the Affordable Care Act, he said.

“We have to be data-driven in how we assess the environment and how we think about the impact on the organization,” says Rutherford. “Preparation, planning and communication are all very important.”

Richard Silveira, chief financial officer of Massachusetts-based Cape Cod Healthcarepredict funding from government programs will decrease in the future, mainly due to the large scale unsubscribe from Medicaid beneficiaries during the eligibility determination process.

Along with inflation, the health system may have to cut costs and leverage its size to negotiate discounts with providers, he said.

Thomas Arnold, CFO at Piedmont Healthcarean Atlanta-based nonprofit, said he believes the economic downturn can ease labor market pressures for hospitals and reduce workforce costs.

Alternative payment models

Financial executives also discussed strategies to implement alternative payment model and increase profits through value-based care.

Vanderbilt University Medical Center recently introduced a package payment program for substance use disorders that adds to its maternal health, weight loss, spine surgery, and surgery programs. orthopedic care. These models provide holistic care and coordination, said Dr. CJ Stimson, medical director of employee health programs and senior vice president of value transformation. allowing hospitals to take more risks while gaining market share.

Corewell Health, a nonprofit integrated health system based in Grand Rapids, Michigan, is also exploring alternative payment options and has developed an internal process to identify high-risk patients to better manage care, said chief financial officer Matthew Cox. For example, if a high-risk patient receiving value-based care has a flat tire on the way to a medical appointment, Corewell will pay for the cost of transportation or replacement repair, Mr. speak. “We treat those patients very differently because we bear the full cost of the care,” he said.


News5h: Update the world's latest breaking news online of the day, breaking news, politics, society today, international mainstream news .Updated news 24/7: Entertainment, the World everyday world. Hot news, images, video clips that are updated quickly and reliably

Related Articles

Back to top button