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Carol Gibbons, RN BSN NHA and CEO of CJ Consulting, brings more than 30 years experience to Revenue Cycle Management to Healthcare businesses through analysis of the process, development of best practices for billing and collections and technology implementation.
We recently checked in with Carol to get her insight on the evolution of revenue cycle management and how she advises practices on staying current with the latest trends and technology. Read on:
Tell us your story. How did you get into revenue cycle management?
I have been consulting with healthcare businesses on billing operations for more than 30 years through all the administrative changes of electronic transmission, to NPI and Meaningful Use.
I started in Revenue Cycle Management as the COO of a company specializing in Long Term Care, Home Care and Physical Therapy. While COO, I was instrumental in developing the appeals process in Maryland for the MAPPS process for Medicaid reimbursement. I was integral in working with a software company to implement online software for providers to assist with eligibility verification at the beginning of the technology development to give practices access to this information electronically.
After moving back to Texas, I started a consulting company – providing seminars for healthcare providers assisting with the implementation of the NPI identifier process, guiding multiple organizations to successful reimbursement. I also worked with a software vendor to develop software for patient payment plans without credit history verification.
What’s your approach to medical billing today?
The biggest challenge I find in healthcare businesses today is the lack of training for billing staff and the reluctance of the owners to invest in technology to improve the payment process. I am constantly looking for inexpensive resources to assist the staff in the clinics where I consult.
Because of the complexity of the billing process, I am actually recommending that the practice consider outsourcing the billing and in most cases, the bottom line improves, even while paying the billing company. I set up a series of reports that we monitor on a biweekly and monthly basis to make sure the billing company’s performance remains better than the previous performance of the practice.
What do you feel differentiates your service and sets you apart?
The service to my clients is exceptionally supportive to the billing staff and helping them set goals with billing targets. We get all the players involved in setting goals so that they can feel successful when the bottom line improves. We understand that just teaching someone the billing tasks without setting up a system for achieving goals is most times unsuccessful.
Can you talk a little bit about the landscape and complexity of your billing?
The billing landscape has changed dramatically in the past five years with the improvement in technology both on the provider side and on the carrier side. Older practice management systems that have not kept up with these technology advancements do not provide the reports and auditing tools now available to billers.
What are some of the common billing challenges you run into on a day-to-day basis? What do you do to overcome these challenges?
My biggest challenge in working with clients is the follow up on charges that are denied. If the dollar amount is small, they tend to go ahead and post the EOB. I spend a lot of time teaching them to investigate every denial to find out why it happened. If the denial is because of the wrong diagnosis code, then we can teach the providers to modify their documentation and prevent that denial in the future.
What do you wish more of your clients would be doing with respect to revenue cycle management? What advice do you find yourself repeating over and over?
My biggest challenge in improving the revenue cycle is convincing physicians that they need more staff members to do all the follow up necessary to collect all their money. Another issue I face is also that they need to increase salaries to get more experienced and efficient staff. Their relatives, no matter how nice, are not generally competent to do billing without extensive training.
How do you advise your clients approach finding the right technology to help manage their practices?
I recommend that my clients do demos of several products and make a list of the features they like the most. We start with a spreadsheet and compare pricing, features and the amount of time it takes to implement the software. After they narrow down to two products, do another demo of the software to see if the vendor can provide the features the staff needs to be efficient in their work. Finally, if possible, go to another clinic to see the software in action and ask them what thing they would like to change the most about the software. Once we have gone through all those steps, one of the products rises to the top for implementation.
What are your favorite tech tools for helping with RCM and practice management?
I generally suggest that they enroll in an online product to give them access to ICD 10 codes and CPT codes. These products make the search for an unfamiliar code more efficient than looking in books. For the coders, I recommend that they join one of the certifying agency’s (AAPC for example) website. Generally, you can become a member even if you are not a certified coder and they have resources to help you with difficult coding issues.
I also encourage the practice to enroll in products that do patient reminders. For practices without EMR technology, I look for products that will also give them access to an online payment portal so patients can pay balances electronically. This is especially important to the upcoming Millennial generation that spend all their time on the phone. If the providers have smart phones, I download an ICD-10 app to help them code more effectively. If they are using their computer to look up a code, many times that means leaving the screen for the chart they are working on. The app is more efficient in looking for the appropriate code.
What’s your plan to stay competitive with major players like Athenahealth, eClinicalWorks and McKesson?
I actually to not recommend any of those top software products. They generally cost more than some of the newer solutions, and many times do not have efficient support. Poor support is the biggest complaint that I get from clients. I do not even demo those products unless a client is really interested in the software for other reasons.
How has the Affordable Care Act affected your business? What about patient pay. What has been the impact on your work?
The exchange products have been major challenge to smaller practices and many of the larger practices do not participate in them at all. The carriers change yearly and patients are forced to move to other providers sometimes every year.
This year especially, many of the larger companies have either pulled back their participation or gotten out of the exchange market all together. The deductibles for many patients are not manageable. Yes, they have insurance, but after that wellness visit, any problems identified as needing follow up are not covered until the deductible is met. As a result, healthcare businesses have more unhappy patients with healthcare bills they cannot pay causing cash flow problems for the provider.
What headlines or trends in the world of revenue cycle management are you following today? Why do they interest you?
I am watching the new OIG plan to help me advise healthcare businesses about updating their Compliance plan. I also am watching the legislation that increases the salary cap for hourly employees to earn overtime and helping practices review their current policies. I am also watching closely the move toward repealing the ACA and how it will be replaced.
What predictions do you have for the future of revenue cycle management? How will the field evolve?
Currently, we see most software companies combining with billing operations to provide those services to their clients. This increases their revenue over just charging software fees. I see better technology already being implemented to track the changes that carriers make regularly and see trends better. This technology will improve efficiency in billing operations whether they are outsourced or remain in house.
We all need a better way to compete with all the changes made by carriers and give us a fighting chance to survive financially. I remember when United Health Care eliminated one frequently used CPT code from the approved list for UAs. That small change saved them millions of dollars because most billers just wrote it off. I also predict that there will be more solutions geared at healthcare businesses to help collect patient balances without sending patients to collections.
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Last Updated on January 31, 2017

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