Revenue cycle management is complex, difficult and costly to manage. Between the complexity of coding, transparency regulations, new market realities and shrinking hospital margins, traditional RCM processes no longer produce the desired results.
Add revenue pressure because of losses incurred during the pandemic, and RCM is more important than ever.
During a November Becker's Hospital Review webinar sponsored by Healthcare Financial Resources , HFRI's Jon Giuliani, VP of operations, and Daniel Low, director of operations, discussed strategies to use automation and analytics to boost performance and streamline the revenue cycle.
Four key takeaways:
- Among RCM challenges are staffing, payers, current technology and data syncing. Accounts receivable representatives in call centers are tasked with extremely complex work. Recruiting for these positions is difficult. Ramp-up takes time, which means turnover is costly. And desk procedures, web portals and EMR systems are constantly being updated, requiring continued focus on training. "Every minute, every dollar you spend working with team members is definitely worth it to ensure that they perform better," Mr. Low said. "Higher performance is going to mean more revenue and better margins."
Payers are a challenge, as they constantly identify codes they don't agree with reimbursing and may hide rejections or underpayments in codes not normally associated with underpayment. Meanwhile, revenue cycle technology has come a long way, but it's not yet considered at the forefront of automation. Those factors combined with market realities have made RCM more challenging than ever for hospitals. "It very much feels like external forces are converging to make it increasingly difficult to consistently optimize revenue cycle management in sustained predictable cash flow," Mr. Giuliani said. - Ensure the account is worked correctly from the outset. HFRI found that when an account is worked incorrectly the first time, it can impact the opportunity to collect by 50 percent on average. HFRI came up with a solution using a guidance process based on intensive EDI 835 mapping to first identify the core issue on the account, which targets a root cause. That root cause is then linked to an automated decision tree and automated notation, which helps eliminate labor-intensive desk procedures. By targeting root causes and automating notes, this solution reduces life cycle time, decreases the cost to collect, improves staff performance — and improves revenue.
Analytics turbocharges HFRI's automated decision program. "We have to be all over analytics, and the automation of information has to be at our fingertips at all times," Mr. Low said. This includes analytics involving EDI data and contract management, as well as a denial scorecard. - Data mapping is worth the time. Part of using the 835 process is the mapping of assorted data combinations related to claim adjustments and remittances. Mapping those combinations into classifications "definitely takes some time," Mr. Low said, "but the data insight and the opportunity for process improvement is 100 percent worth the energy and effort."
- Ensure process flows and procedures are detailed, up to date and automated. The more detailed your processes, the more efficient your staff is going to become, Mr. Low said. And the more processes are automated or built into the system, the less the team has to pivot, saving them significant time.
To view the full webinar, click here.
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