If one thing in healthcare is an unwavering constant, it is that patient health is, and always will be, the top priority for any hospital.
It’s the truest indicator of success and for good reason. But to ensure that goal is consistently met, healthcare organizations of all sizes need to be active in how they manage and optimize their revenue cycles. A recent Gartner report offers an in-depth look at how to better position your organization for better revenue capture and to build a solid financial foundation. As I read through the findings, I was immediately struck by not only how important these steps for RCM optimization are, but also by how easily accomplished they can be with the right health IT partner. Here are some highlights I think are relevant for any organization.
The post-COVID-19 need for RCM optimization
Hospitals are managing the clinical demands the coronavirus brought forth but given the drastic reduction in revenue-generating services, (e.g., elective surgeries), financial recovery is very much top of mind. According to the report, most healthcare organizations’ CFOs cite revenue improvement and business growth as their main goals in the wake of the COVID-19 pandemic. Under these pressures, though, the report warns against organizations getting their hopes up too high with new vendors pledging a robust return on investment and major enhancements in RCM technology. In reality, many organizations have ample opportunity to maximize their existing RCM technology. To do so, the report recommends organizations focus on three key phases to truly optimize their RCM practices.
The three phases of RCM technology optimization
To bolster their existing RCM technology foundations, Gartner’s researchers identified three broad phases organizations should take toward digitalization success. The first is to deploy the technologies that best span the core RCM processes, such as an RCM billing system, claim editor, patient eligibility and verification system, and encoder. The second is to optimize the current technology and “exploit all of your RCM system’s capabilities to extract its full value and become completely prepared to extend into RCM digital transformation to maximize total ROI.” The final phase of optimizing your current RCM system is implementing artificial intelligence, RPA and predictive analytics solutions to better support the revenue cycle value and faster cash acceleration. When organizations invest in digitalization, the impact is considerably lower when compared to the organizations that have taken a step further and first fully optimized their foundational RCM IT technologies. The increased value over time is significant.
Assess your organization’s digital transformation readiness
When it’s time to add new RCM technology, it’s wise to assess exactly how prepared your organization is to undergo such in-depth technological optimization. The report offers a comprehensive self-assessment questionnaire that will illuminate all the areas of your RCM transformation readiness you’ll need to ensure a successful digitization outcome.
From there, the report encourages organizations expanding their RCM technology to employ “common key performance indicators” (KPIs), e.g., clean-claims rate, medical coding accuracy, denials rate and account receivable days. KPIs “help revenue cycle leaders and IT teams understand the strengths of your business and identify areas for process improvement.” In using these KPIs, organizations can quantify success and easily compare with other industry top performers to identity optimization opportunities.
Finally, it’s time for the optimization and subsequent addition of new RCM technologies. As you’ll see in the report, there are three RCM processes you’ll want to optimize immediately, once your organization is fully prepared. I’d like to highlight two of these to demonstrate how this can be achieved with Sunrise™ Financial Manager.
1.) Increase electronic claims submission rate to 95% or higher – Improve claims processing time and accuracy and deliver faster payments by eliminating any manual errors and lags commonly associated with paper claims processing. Integrating with nThrive pre-claim editor, Sunrise™ Financial Manager includes more than 29,000 claim edits for accurate claim submission.
2.) Improve cashflow and reduce A/R by mapping all denial codes in the RCM system – Improve A/R days and cashflow through expedited posting and by moving balances due to the next responsible party (payer or patient). Sunrise Financial Manager has extensive, in depth configuration to not only map all denials but to handle exceptions and move balances forward to the next responsible party. Using Allscripts® Clinical Performance Management for financials, organizations can report on trends and identify opportunities for improvement.
The report dives deep into why it is so important for organizations to optimize their RCM processes, but it also gives great advice on strategies and execution. Allscripts is also a great source of this advice and offers robust, end-to-end RCM solutions that not only optimize RCM best practices, but to also help build and strengthen organizations’ financial foundations for better outcomes across the board.
Read the full Gartner report here.
Editor's Note: This article originally appeared on Allscripts' website.
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