1. 2015 saw a wave of unprecedented Mergers &
Acquisitions (M&A) between large and community payers
and providers. The reasons vary, but operationally
and financially these organizations require system
interoperability and technology consolidation to reduce
redundancy and gain economies of scale.
Also, as health insurers and healthcare organizations
transform into value-based reimbursement environments
and respond to other Affordable Care Act (ACA)
mandates, brand new technologies are required to
predict and maximize cash flows for reinvestment and
protection against unforeseen challenges.
The CFO Challenge
During M&As, the CFO’s office could be faced with the
following challenges:
TheCF0
Solution
Simplify
the business
of healthcare.
Involving Healthcare Finance in Choosing
Reimbursement Technology

2. 1Payment of claims and rework from multiple claims
administrative platforms
2Financial performance for multiple distinct government
and commercial products
3Multiple medical economics and finance departments
attempting to merge and scale
Many organizations
transforming into value-
based reimbursement
environments could be
faced with the following:
1. First-time need to manage claims reimbursement
(Note: Upwards of 120 providers operate their own
health plans today, according to Valence Health,
and experts forecast that figure to increase.)1
2. Claims administrative platform unable to handle new
reimbursement models
3. Insufficient analytics to assess and operationalize
value-based payment models
Without the proper reimbursement analytics, Finance
departments run the risk of unexpectedly tapping into
their cash flow reserves to pay higher than anticipated
reimbursement amounts. In addition, the CFO has to be
concerned about overpayments and the related stress
on cash, since a recent American Medical Association
(AMA) study estimates that 7.1% of claims have a
payment error.2
The industry should examine best practices for
managing reimbursement between payers and providers,
or healthcare organizations, especially since the ACA
is mandating CMS to require new reimbursement
methodologies, like the Comprehensive Care for Joint
Replacement (CCJR) model3
, which requires payers to
move away from insufficient and antiquated technology
from vendors and internal departments.
The net result is a challenge for CFOs to predict and
successfully manage the organization’s cash flow.
The CFO Solution: Involving Healthcare Finance in Choosing Reimbursement Technology
2
Simplify
the business
of healthcare.

3. The CFO must be a
change agent for leverag-
ing new technologies
for reimbursement
management.
Let’s examine three ways the CFO’s office should
become engaged.
Leverage The
Delivery Model
Software as a service (SaaS) technology, a delivery
model centrally hosted in a secure data center and
managed completely by the service provider, is licensed
on a subscription basis. It enables a single accessible
and consistent claims reimbursement pipe for one or
more of an organization’s information systems.
Selecting services with different types of analytic
reporting and modeling features enables CFO offices
to better track reimbursement activity and forecast
the impact of government regulatory changes for
the coming year.
Simplify
the business
of healthcare.
The CFO Solution: Involving Healthcare Finance in Choosing Reimbursement Technology
3

4. Make F&A Reimbusement
Stakeholders
Often, software and its value to the business are
assessed by Operations and IT stakeholders. It is true
that SaaS solutions offer many operational benefits
like a lower total cost of ownership (TCO), or the direct
and indirect costs of owning software, and efficiencies
through automation of business processes and reduction
in human errors. However, these benefits only tell half
the story, and often result in the wrong technology
partners for the organization.
This is where the CFO needs to become active in the
organization’s technology plans. The CFO should
consider an assessment of the technology’s impact
on medical costs and cash flow. Many reimbursement
software solutions can be delivered as SaaS, but that
doesn’t mean all can keep up with the fee schedule
and payment policy changes made available daily by
CMS. It also doesn’t mean that the reimbursement
software leverages the correct technology to provide
the necessary reporting and analysis on reimbursement.
Quite simply, the CFO
should weigh in on which
reimbursement solutions
have the platform and
process to:
1Predict reimbursement spend for each line of business
2Accurately reimburse claims
3Analyze reimbursement trends throughout the year
The return on investment (ROI) for each software
solution will then change, and often a different vendor
solution will be chosen for the organization.
Find a Partner,
Not a Vendor
It is natural to look to what other organizations are
doing to alleviate financial concerns during this time of
payment reform. Often, references, assessing trends
and your budget are reasonable ways to choose vendor
solutions. The problem is, looking for vendors based on
Simplify
the business
of healthcare.
The CFO Solution: Involving Healthcare Finance in Choosing Reimbursement Technology
4

5. these variables tends to result in a more generic
solution that does not take the unique aspects of your
business into account.
Instead, examine a partner willing to live by the following:
1. Mutually take on risk and gain based on success
2. Commit to establishing key performance indicators
for success
3. Introduce their own strategic partners and innovative
ideas that contribute to your strategy, even if it is
outside of their core competency
4. Commit to product enhancements based on your
business need
It’s not about software off the shelf; it’s about
building a long-term relationship.
Should you find yourself
in a chronically leaking
boat, energy devoted to
changing vessels is likely
to be more
productive
than energy
devoted to
patching
leaks.4
Conclusion
Cash flow management in the face of ACA mandates
and claims payment reform remains a challenge. CFOs
must prepare for changes in their cash management
strategy, including by becoming major stakeholders in
claims reimbursement management. It is critical that
they assess the right technology, shift ROI assessment
to be financial and operational (instead of just
operational) and adopt business partners who do
more than vend software. Only then can we say, with
confidence, we are on the road to removing this type of
daily cash flow distress.
Jared Lorinsky serves as the Senior Vice President of Business
Development for Burgess. On a daily basis he engages with clients
on a variety of next generation solutions for the healthcare industry,
including new payment models, government informatics and
transparency systems.
References:
1. “CEOs and CFOs: 10 things demanding your
attention this year”:
http://www.beckershospitalreview.com/finance/
ceos-and-cfos-10-things-demanding-your-attention-
this-year.html
2. “AMA: Insurers process claims faster, more accurately”:
http://www.healthcarepayernews.com/content/ama-
insurers-process-claims-faster-more-accurately#.
VqZQmfkrK71
3. “Comprehensive Care for Joint Replacement Model”:
https://innovation.cms.gov/initiatives/cjr
4. Warren Buffett
The CFO Solution: Involving Healthcare Finance in Choosing Reimbursement Technology
5
If you would like more information on how we
simplfy the business of healthcare while increasing payment
integrity, please contact us:
info@burgessgroup.com
800.637.2004
burgessgroup.com