Becker's Hospital Review

20 CFO / FINANCE Revenue cycle leaders should be 'unyielding with vision,' MetroHealth's Donna Graham says By Kelly Gooch D onna Graham uses her strategic plan- ning background to guide revenue cycle initiatives at the MetroHealth System in Cleveland. She is the system's executive director of reve- nue cycle and has worked for academic med- ical centers, multispecialty healthcare deliv- ery systems and medical practices. She also led a strategy firm that serves U.S. hospitals and providers. Becker's Hospital Review spoke to Ms. Graham about how MetroHealth is han- dling revenue cycle challenges and advice she would give to other hospital revenue cycle leaders. Editor's note: Responses were lightly edited for length and clarity. Question: What is one thing that piqued your interest in becoming a revenue cycle leader? Donna Graham: Being a revenue cycle lead- er means being able to thrive as a change champion. All patient revenue-producing initiatives, whether via claims adjudication or moving into value-based pricing, impact my team and me. As a revenue cycle leader, it has been said that we can manage the front end, middle and back end or any variation of the same. at is old nomenclature. We are caregivers. We navigate the complexities of healthcare and promote preventive care and the continuity of care. Whether managing or mentoring, I think of revenue cycle lead- ers as a Peloton [bicycle]. We are the hub. e spokes represent the areas of integration impacting healthcare systems, and the han- dlebars are the consumer providing the di- rection we need to take to meet their needs, expectations and values. No point in discuss- ing the seat, because as revenue cycle leaders, if we sit down, we are at risk of slowing down. I have been able to be strategic, innovative and a driver to support community members be- fore they become patients. Whether through our 38-foot "Enrollment on Wheels" RV, sup- porting our patients 24/7 within our four hos- pitals and 26 clinics in person, our tele-finan- cial coordination or being an empathetic ear within our patient advocacy contact center, we are able to positively engage, embrace and be an integral influence for a healthier commu- nity. By sharing knowledge with colleagues, I have been able to collaborate with government relations to lobby on behalf of my hospital, which could also positively impact hospitals around the country. I am fortunate to have what I refer to as a triad of experience: clini- cal operations, information technology and fi- nance. is has helped me immensely because I can understand the strengths and opportuni- ties for enhancements throughout our health- care system and others. Q: What is the biggest challenge you face as a revenue cycle leader today and how do you address it? DG: e degree of discussions around denials continues to be driven by the magic formula of what is the best soware, who would be best to manage rejections, what are the most effective ways of working with payers, and, of course, how do we get paid with a single touch versus appealing. Last year, I promoted a change in our thought processes. We no longer use ex- ploitation; we emphasize exploration. Instead of a denial management team, we have stra- tegic appeal specialists. We no longer refer to denials. Denials are those claims with adjust- ments. We refer to the [explanation of benefits] nonpayments as rejections, and our mantra is, "With a little bit of SAS, we have the momen- tum to avoid rejections." I also created a collaborative group with pro- viders, management and support teams to move toward centralization. We call it the STAR Program, for Scheduling, Technology, Authorizations and Registration. is facil- itated measuring what multi-diverse teams could improve and what technology could be optimized. A payer assessment report was created for our large payers so we could share Tennessee hospital plans to reopen after abruptly closing in June By Ayla Ellison W est Palm Beach, Fla.-based Rennova Health is taking steps to reopen Jamestown (Tenn.) Regional Medical Center after closing the 85-bed hospital in June, according to the Independent Herald. CMS terminated its provider agreement with Jamestown Regional June 12, and the hospital abruptly shut down the next day. In a statement to the Herald, Rennova, which owns Jamestown Regional, said mistakes made during the transition to a new billing company in December 2018 led to financial challenges at the hospital. The company said mistakes made during the billing company switch also caused other problems, including the decision by CMS to terminate the hospital's Medicare and Medicaid funding. Rennova said the hospital closure is temporary and it has applied to re- store Jamestown Regional's provider agreement with CMS. A Medi- care administrative contractor completed its assessment of the ap- plication and made a recommendation for approval to the Tennessee Department of Health, a Rennova spokesperson said Aug. 19. The spokesperson said the hospital will begin rehiring staff and preparing for surveys. State inspectors, acting on CMS' behalf, will conduct the surveys to ensure the hospital is in compliance with Medicare's conditions of partici- pation. CMS will not approve or deny the hospital's application until it deter- mines whether all Medicare conditions are met, according to the report. "We are excited to reopen and provide healthcare to the local and surrounding area and while we do not yet have a date set, we will be working diligently to ensure reopening happens as soon as possible," Jamestown Regional CEO Mi- chael Alexander told the Herald. n

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