3 Strategies for Revenue Cycle Management Optimization

3-strategies-for-revenue-cycle-management-optimization

Optimizing revenue cycle management is pivotal in rebounding from the profound losses of the previous year. Leading provider organizations have devised three potent strategies.

In the aftermath of the COVID-19 pandemic, fine-tuning revenue cycle management takes precedence for financial leaders. Last year, healthcare institutions grappled with substantial declines in both revenue and patient volume, all while healthcare providers were diligently safeguarding patients from a perilous and highly contagious virus. The dual challenges, both clinical and financial, exacted a toll on organizations, resulting in the unfortunate closure of some.

Presently, healthcare financial leaders are directing their efforts towards recovery in a post-pandemic era. With the majority of Americans now vaccinated, patient volumes and revenues are gradually approaching pre-pandemic levels. However, COVID-19 expedited specific trends, such as healthcare consumerism and the escalation of healthcare expenses. As a result, healthcare organizations face the imperative of reengineering their processes to ensure a seamless revenue cycle in the times ahead.

1. WORKFLOW AUTOMATION

The healthcare revenue cycle presents a prime opportunity for automation. Within revenue cycle management, team members often engage in numerous repetitive tasks, such as eligibility verification, claim status follow-up, and patient statement creation, all aimed at achieving accurate and swift reimbursement. However, technology can step in to automate these functions, liberating team members to focus on more intricate and value-driven responsibilities.

In Dallas, Texas, the Eye Center has embraced automation for this very reason. The specialized practice recently automated elements of their accounts receivable (A/R) management.

The revenue cycle director, said, “You have your practice management system, and you have all of these thousands of claims sitting out there. Trying to determine which ones need attention and which ones don’t, it’s a very manual process going through those.” He highlighted how the implementation of RCM automation software significantly enhanced their ability to organize claims, optimizing the efficiency of their A/R staff. This shift also enabled him to track their productivity, resulting in a remarkable 38 percent reduction in A/R over a span of 60 days within the initial three months.

Moreover, implementing workflow automation at the forefront of the revenue cycle proved invaluable for practices during the pandemic. South County Urological in Missouri, for instance, had already automated patient financial clearance before the pandemic struck. When COVID-19 did arrive, the office manager attested that the tool became a game-changer.

Through automation, the practice streamlined patient clearance days prior to appointments, negating the need for unnecessary physical contact, particularly during periods of strict distancing measures. This adjustment was particularly impactful during the surge in telehealth appointments.

Reflecting on the experience, the office manager noted, “The biggest thing we learned is that we really should have done something like this a long while ago”.

2. FRONT-END OPTIMIZATION

Enhancing the efficiency of front-end revenue cycle procedures can alleviate challenges in the later stages. This has proven particularly impactful for Goshen Health, where patient access stands as a crucial factor in the success of revenue cycle management within the Indiana health system.

 The director of patient access, emphasized in a recent interview, “From the patient’s perspective, we are the first interaction for their visit. We have only one chance to make it an exceptional experience. How the patient experiences patient access can impact the remainder of their visit.”

Continuing, Plank noted, “From the hospital’s perspective, our ability to accurately input insurance information, verify precise patient demographics, and collect the patient’s financial responsibility upfront serves to minimize rework throughout the revenue cycle, ultimately reducing the potential for denials.”

To streamline this front-end process, Goshen Health has undertaken a modernization initiative. While approximately 30 percent of health systems still rely on manual patient access workflows, the increasing tech-savviness of patients, driven by smartphones and technological advancements, has prompted Goshen Health to leverage features like automated and bi-directional communications.

Furthermore, health systems such as Goshen Health are actively working to streamline registration workflows, particularly in the aftermath of the COVID-19 pandemic.

“Engaging with our patients digitally for patient intake has enabled us to offer contactless registration, ensuring safety for both the patient and our colleagues,” stated Plank. “It allows them to verify their demographics, capture an image of their insurance card and photo ID, as well as electronically review and sign their consent—all at a time that suits the patient’s convenience.”

3. FIND A PARTNER

Streamlining revenue cycle management can present a formidable challenge, especially for smaller healthcare organizations. Physician practices may find themselves lacking the necessary resources, such as capital, technology, and personnel, to embark on a comprehensive optimization endeavor. Additionally, swiftly expanding organizations may grapple with a patchwork of disparate revenue cycle processes and technologies, hindering seamless enterprise-wide management.

For certain organizations, these circumstances may signal the need for a strategic partnership. The practice of outsourcing revenue cycle management has gained traction as a solution to common challenges, including delayed reimbursements, inefficient workflows, and technological limitations.

In the wake of the COVID-19 pandemic, outsourcing is poised to experience a renewed surge in popularity. The pandemic has exacerbated difficulties in talent acquisition and retention. For some organizations, maintaining an internal revenue cycle management team may not be currently viable or cost-effective. This was the situation faced by Tucson Gastroenterology.

Contract administrator, explained in an interview, “Some people had been there for a long time, like 19 years, and they were retiring and moving on. We were losing some key billers that had known the practice and were leaving in 30 days times.”

Consequently, the specialty practice in Arizona opted to engage a third-party revenue cycle management company. As a result, the practice has experienced improved operational efficiency internally and gained enhanced visibility into its billing practices.

However, it’s worth noting that revenue cycle management outsourcing may not be a perfect fit for everyone. Approximately one-third of providers have expressed regret over their decision to outsource, often due to dissatisfaction with their third-party vendor.

For a successful partnership, Wester advises other practices to consider factors such as the vendor’s expertise in their specific specialty, its ability to integrate with existing systems like EHRs, and the robustness of its support system.

“It’s really important that we have an advocate, a specialist, who knows this site and can answer questions because one of the most frustrating things is if a key player can’t answer questions and you get routed to a 1-800 number. To me, that’s the least effective way,” he emphasized.”

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