From obtaining and validating patient demographic and insurance information to medical billing and claims submission, Revenue Cycle can be a lengthy and complicated process.
Correctly completing each step in the process helps ensure appropriate, timely payment from a payer. But the complexity of Revenue Cycle workflows often confounds speed and accuracy.
Getting the process right also means a consideration of the patient experience. Offering greater service, convenience and transparency are—or should be—high priorities for today’s Revenue Cycle leaders.
External factors, like an increase in uncompensated care and a shift to value-based care, further complicate planning cycles for Revenue Cycle departments, all of which begs the question: What types of initiatives should RCM professionals focus on in 2020?
No Easy Button
In the decade ahead, advances in Robotic Process Automation (RPA), Artificial Intelligence (AI) and Blockchain all show promise for improving Revenue Cycle operations.
But there is no ‘easy button’ to resolve every pain point that faces most health systems. Instead, I advise clients to look holistically across their Revenue Cycle to identify and address key gaps in process, training and technology.
Annual planning that addresses each of these focus areas can improve results, while ensuring that Health Systems remain adaptable to large-scale, macro level healthcare shifts. With that philosophy in mind, here are four key strategies that I think should be part of the Revenue Cycle project roadmap for most providers in 2020 (and beyond).
Enterprise Focus on the Patient Experience
With the healthcare market shifting towards consumerism, there is an advancing expectation to focus on the patient experience. Between the payer and the provider, patients can be contacted dozens of times throughout the lifecycle regarding their insurance/financial responsibilities which can be confusing, and sometimes conflicting information between the two organizations.
By applying an Enterprise Focus on the Patient Experience, Health Systems can meet their patient’s expectation through operational adjustments, like implementing a patient contact center to reduce points-of-contact to the patient. Shifting focus to the patient experience will be invaluable as patients increasingly shop for care based on price and experience.
Supporting Technology to Optimize Workflow
Considering the number of hand-offs within the Revenue Cycle, this step is key to ensuring a seamless transition between staff members across the front-end and back-end revenue cycle.
By implementing Supporting Technology to Optimize Workflow, Health Systems can streamline hand-off points between different Revenue Cycle functions, specifically focusing on improving metrics, such as clean claim rate, Days Sales Outstanding (DSO or A/R Days), and denial rate to maximize cash collections.
Real-Time Reporting and Analytics
Decision making can be a difficult task without a data-driven revenue cycle. Financial and Clinical Key Performance Indicators (KPIs) need to be established and tracked against benchmarks to evaluate the overall health of the Health System.
By establishing Real-Time Reporting and Analytics, Health Systems can be strategic and proactive in their approach to improving the revenue cycle metrics. Developing a dashboard is key to identifying and resolving a Health System’s Revenue Cycle pain points.
Standardized Quality and Training Program
Workforce optimization is a major component of improving a Health System’s Revenue Cycle operations. An optimal workforce starts with proper training, productivity and quality monitoring, and establishing goals to which to hold your staff accountable.
By launching a Standardized Quality and Training Program, Health Systems can identify knowledge gaps, and identify improvement opportunities across the Revenue Cycle. Health Systems that make an investment in the professional development of their workforce can have an immediate impact to its Revenue Cycle operations.
Colin Batherson is Associate Director, Revenue Cycle Operations for Healthcare IT Leaders. As an RCM transformation consultant, Colin has led comprehensive payment reviews for several large hospital systems, while advising on the development and implementation of centralized billing and revenue cycle analytic programs.