For over seventeen-plus years, Vishal Ganju has served in all areas for healthcare provider landscape: physician’s office, hospital consulting, hospice and palliative care, and, now, medical supplies. He has won awards for revenue cycle technology innovation, process efficiencies, managed care growth, and many more.
Numerous IT solutions enhance the work of revenue cycle professionals. Human interaction, however, creates real, consistent success, according to Ganju, vice president revenue cycle management for managed care at Medline, a distributor of medical equipment and supplies. The seasoned revenue cycle executive believes two key factors remain critical for a high-performing revenue cycle function. One, cultivating personal relationships with people in payer organizations—sometimes including high-level executives. Two, assembling a staff with the right skills.
With profit margins under continuous pressure, the back-of-the house, largely invisible revenue cycle department remains more vital than ever to financial viability. “Administration costs on both the payer and provider side are insane,” Ganju observes. Best practices in provider revenue cycle departments should equate to 5 percent or less of claim denials, he insists. At the same time, rates in laggard revenue cycle organizations can be a high operating expense due to labor cost and inflation.
Simple solutions to reach high-performance status don’t exist, Ganju says. No technology vendor has the tools to meet all revenue cycle needs. As well as the fact that healthcare generally lags ten to fifteen years behind other industries in IT implementation.
That’s not to imply technology isn’t an important part of the picture. Indeed, data analysis brings patterns of denials or underpayments to light. When such a pattern is identified, do a deep dive to deduce the source of the problem, Vishal Ganju advises. After that step, human intervention and interaction is critical. “If you consistently are not getting paid for a service, find out what is the payer’s position,” he says.
To get an accurate read, staff must get in touch with the right personnel on the payer’s side. With rules governing what procedures are covered constantly changing, some of the payer’s representatives are likely not up to speed on how and why payment policies on certain claims have changed. Knowing who on the payer side is most knowledgeable, then, is advantageous.
When his staff can’t find a good answer on a pattern of claims denial, Ganju doesn’t hesitate to contact high-level managers in payer organizations—sometimes even at the CFO or CEO level. Typically, he gets a positive response. “When I have done that, nine times out of ten, they have jumped on the problem,” he says.
Dedicating staff to sift through denial and underpayment analytics regularly is a must, Vishal Ganju says. A quality assurance team conducts audits, randomly sampling denied claims. “A small organization might consider such a dedicated resource a luxury, but they are surprised about how much they would save if they had one in place.” The smallest organizations could assign one person to claims quality control part time and still make significant improvement.
Those focused on analytics should flag denial trends—cases with similar roots having significant financial impact. Find out what your organization can do to conform to new claims rules. This approach, tackling multiple denials with common causes, produces systemic change that reaps ongoing benefits—far more than addressing denials on a case-by-case basis.
With so much riding on the skills of team members, revenue cycle managers must be good people managers, Ganju says. “If you do not have the right team with people in the right places with the right attitudes, you are bound to fail.” Assembling and training such a team is the manager’s chief responsibility. Don’t expect to just implement IT tools that you hope will automate good revenue cycle practices, he emphasizes. With many payers having widely diverse rules and terminology, such a vision is a pipe dream.
Ganju believes in choosing staff carefully and providing them with specialized training for their roles. “Revenue cycle is not for someone who likes the status quo,” he says. “You have to be nimble, because things change so much on the fly.” With constantly changing claims rules, all revenue cycle personnel must also be attentive to detail.
Data analysis drives revenue cycle improvement. Without it, your department can’t be a top performer. Thus, those with the acumen to “slice and dice data” are essential assets, Ganju notes. Hiring smart, capable people with interpersonal skills to fill those and other roles gets you part of the way to high performance, but good training is essential.
“There is no revenue cycle degree,” Ganju observes. Staff members must learn the ins and outs of revenue cycle management on the job. While onboarding remains a key period, training must be an ongoing, long-term process. Providing staff with consistent feedback on performance also is critical to their development. To raise overall team performance, he advises spending more time training those who are not the highest producers.
The nature of revenue cycle creates constant challenges, so those seeking a career in the field must accept that and have the temperament to adapt to new conditions constantly. Vishal Ganju is one who has embraced and thrived in this dynamic environment. “Revenue cycle in some sense has muscle memory, but it keeps changing,” he says. “It keeps you on your toes. That’s why I love it.”