Here are five revenue cycle management tips from industry experts, published by Becker's Hospital Review since April 9.
1. "In January 2011, the RAC program was initiated to identify improper Medicare Part D payments that could be costing the government several millions of dollars. According to the fiscal year 2015 report, the RACs identified and corrected $440.69 million in improper payments. There were $359.73 million collected in overpayments and $80.96 million in identified underpayments paid back to providers.
"CMS will continue to audit payments to reclaim overpayments and restore underpayments in a ratio that seemingly benefits CMS far greater than the providers. The next opportunity for identifying revenue streams may reside in an audit process for all insurance payers." - Julie Vigue, strategic business development executive at eVOLUTIONcr
2. "For hospitals and standalone healthcare providers, it's all about delivering top-quality care, not necessarily managing the revenue cycle. Collecting payment is crucial to success. But chances are it's not a core competency.
"In fact, 57 percent of businesses outsource because it allows them to concentrate on what they're good at, according to Deloitte. Focusing on the core business is the second most popular reason to outsource, just two percentage points behind cost-cutting. Outsourcing revenue cycle management to an organization that understands the process often is an excellent choice.
"While most companies outsource to save money, I'd argue it's equally important to get outside help because it allows a healthcare organization to focus on what it does best, which is providing patient care.
"By outsourcing the revenue cycle management process, healthcare businesses can reallocate human and financial resources to use them in other parts of the business, and utilize the most up-to-date services." - Joel Gleason, senior vice president and global market head of the provider segment at Cognizant
3. "The revenue cycle management team has a unique view of the day-to-day operations of a hospital — sometimes, even more than a specific nurse department. This is because the RCM team sees everything that is going on. Your RCM team knows the rate claims are being pushed out, the rate at which patients are being treated and much more. Leverage this knowledge to identify faster and easier ways to improve the efficiency of your business operations." - Kenneth Miller, senior revenue cycle management specialist at Cantata Health
4. "Nationally, the acquisition cost of blood products is approximately $4 billion each year with additional costs for testing, processing, administration and adverse events driving a true cost of transfusion at an estimated $15-20 billion in healthcare. Within 18 months, one large health system realized a $4.4 million reduction in blood acquisition costs (patient volume adjusted) that was accomplished by implementing a comprehensive patient blood management program with active participation from hospital departments and specialties as well as support from executive leadership, medical staff, nursing, pharmacy and the laboratory.
"Less is more for transfusions — a more restrictive approach not only saves blood but, also saves lives." - Joseph Thomas, BSN, RN, national director of clinical optimization at Accumen
5. "Comprehensive patient blood management programs are an essential part of enterprisewide strategic initiatives and are proven to reduce the utilization of blood by up to 60 percent with improved clinical outcomes. This is consistent with a strategic vision of enhancing innovation in patient care at a lower cost as healthcare initiatives drive value-based care and population health management.
"A critical component of accelerated success and sustainability is establishing a strong clinical infrastructure with metrics and goals as well as clinical best practices. By leveraging meaningful data and benchmarking, PBM teams can identify opportunities for improvement and drive accountability at the department and provider level." - Joseph Thomas, BSN, RN, national director of clinical optimization at Accumen
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