In A Revenue Cycle Partner, Customization Should Be Fundamental

Chandler Barron is president of Parathon, which provides hospitals and health systems tools to collect all the revenue they have earned.

There's an intensifying arms race in the revenue cycle. Many payers are erecting more and more obstacles to prevent hospitals from securing the revenue they're owed. For hospitals and their revenue cycle partners, keeping up requires systems that can adapt—essentially, your software must be able to "zag" when payers "zig." As most hospital revenue cycle directors know, payers are doing plenty of zigging, and all too often, providers and their revenue cycle partners struggle to keep pace.

The High Cost Of Static Solutions

This struggle frequently arises because developers often move on once a software solution is launched and implemented, leaving the software static. In a landscape where payers constantly try to gain the upper hand, static software can lead directly to lost revenue.

As revenue cycle directors are acutely aware, the hospital revenue cycle is in continuous flux, with payer requirements evolving and expanding in complexity. Without revenue cycle partners that offer ongoing customization and development as payer requirements shift, hospitals risk falling behind—unable to secure the reimbursement they deserve.

However, many revenue cycle partners are hesitant to invest in the necessary customization of software that manages claims. Unfortunately, this reluctance is common. Once a contract is signed, many partners are reluctant to invest additional developer time into refining or adapting the software, especially when it may benefit only one client. Additionally, in some cases, development resources may have already been reassigned within a larger corporate structure, leaving clients with limited support.

Consequently, customization requests are often met with delays or prohibitively high quotes designed to discourage such requests, effectively blocking hospitals from getting the tailored support they need.

The Opportunity To Innovate

In today's complex and fast-evolving revenue cycle environment, innovation and adaptability are not optional—they are essential. Partners must prioritize continuous development and refinement, equipping hospitals with tools to swiftly respond to payer changes and stay competitive. Customization, far from being a luxury, has become a survival imperative in a landscape where even small inefficiencies can have significant financial repercussions.

For example, we originally designed our database to provide full control over the revenue cycle from a single desktop across disparate electronic health record systems. This clarity and efficiency enable staff navigating multiple systems to seamlessly execute their tasks without toggling between platforms.

However, the database also safeguards against disruptions by providing a fully functional backup system in the event that a cyberattack paralyzes a hospital's primary billing database—which was not among our original goals when developing the tool. This highlights the value of proactive, forward-thinking development.

In another example, Phoenix Children's and Philips Healthcare partnered to co-create innovative solutions tailored to pediatric imaging. Although the project was aimed at achieving advances in clinical imaging, it also resulted in new dosing protocols and child-sized equipment that are now standards in children's clinical imaging for Philips products worldwide.

How To Advocate For Your Hospital

In the ongoing tug-of-war with payers, hospitals often find themselves at a disadvantage. Payers, with their size and control over financial resources, can easily dictate terms and bog down providers with red tape. In this complex and ever-changing revenue cycle landscape, access to critical, adaptable technology and data insights is the most direct way for hospitals to level the playing field. Hospitals must advocate for partners that offer more than just basic support—the partner must be committed to continual improvement and customization.

Most revenue cycle vice presidents and directors understand the value customization can bring because they're close to the action. However, chief financial officers often make the final decision on a vendor, so revenue cycle directors or vice presidents must ensure they don't make that decision solely on price.

Your CFO can be a vital ally in ensuring you end up with the right partner. Answers to the following questions will go a long way toward understanding the level of flexibility and customization you're likely to experience after the contract is signed:

• What flexibility does your software offer in adapting to specific billing rules?

• How do you allocate developer time for your clients, and how much is available?

• Do you offer custom development resources to adapt to our hospital/health system's coding logic and workflow processes?

• What resources do you offer to help align with the specific needs and regulations of our organization?

If you don't like the answers, keep moving.

Hospitals that demand flexibility, innovation and a willingness to develop customized solutions are positioning themselves for long-term success. Access to up-to-date technology and the ability to respond to evolving payer requirements will help ensure hospitals can secure the revenue they're owed, minimizing disruption to patient care and maintaining financial stability.

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