From registration to claim submission to patient collections, revenue cycle management (RCM) encompasses a wide array of processes and services that impact nearly every dimension of healthcare.
Several challenges — some ongoing, others new — exist in the RCM space. These problems include:
- Workforce shortages
- Lack of patient-centered processes
- Inefficient workflows causing delayed payments and mismanaged time
- Poor technology integration and interoperability
- Difficulty adapting to and complying with regulatory changes
When combined, these vexing issues can result in massive losses for practices. Research shows that independent doctors might miss out on as much as $62,000 per year. This lack of revenue jeopardizes practices’ future in an era of dwindling private practices; data from the American Medical Association shows practice ownership is at a historic low. Furthermore, a survey by The Physicians Foundation found that eight percent of physicians closed their practices due to the pandemic. The majority of respondents “agreed that COVID-19 will lead to a reduction in the number of independent physician practices in their communities.”
However, there’s good news. Advances in RCM can help practices optimize their finances, remain viable, and continue to provide compassionate, much-needed care to patients. Here are four exciting trends with actionable steps independent practices can take to solidify their RCM.
Embrace AI, Technology, and Automation
According to researchers, the “rapidly transforming healthcare system and adoption of digitalization” are two key drivers of the industry’s boom. Amid workforce shortages, technologies such as artificial intelligence and robotics process automation (RPA) can make processes more efficient by decreasing manual operations. Additionally, smart software can enhance billing and coding. Together, these powerful programs can boost:
- Coding accuracy
- Revenue capture
- Claim management
- Office productivity
These next-generation RCM tools are most effective when seamlessly integrated with your electronic health record (EHR). The results can be game-changing. As Shahid Shamim, MD, who uses an advanced coding service, noted: “I’m increasing revenue and decreasing stress.”
Technology can also support the front end of RCM through self-service models designed to improve the patient experience. Self-pay kiosks, mobile apps, and a robust patient portal empower patients to manage their care. These tools can allow patients to complete their paperwork ahead of time, pay their balances online, update their demographic information, and more.
Adjust Processes to Support Changing Payer & Patient Landscapes
Since RCM intersects with many dimensions of healthcare, it’s important that we not only responsively refine our operations, but also proactively monitor trends in the larger ecosystem. In recent years, high-deductible health plans (HDHPs) have skyrocketed in popularity. Data shows that more than half of American workers covered by employer-sponsored insurance are enrolled in an HDHP. As patients’ share of costs increased, so too have practices’ self-pay accounts receivable (A/R). An unexpectedly large bill can damage the patient experience, which in turn may sour the vital doctor-patient relationship and even lead patients to seek care elsewhere, negatively impacting practice volume. To avoid this unfortunate scenario, practices should boost their patient communications using a diverse toolset, such as portal messaging and texting services. Automated insurance-eligibility checks as well as electronic statements and payment options can also improve patient satisfaction, engagement, and payments.
Advances in revenue cycle management can help practices optimize their finances, remain viable, and continue to provide compassionate, much-needed care to patients.
Additionally, the industry should consider the impact of value-based care’s progress. To meet the needs of the volume-to-value transition, revenue cycle teams should cultivate relationships with clinical partners to develop risk-management arrangements that embed access and quality, two cornerstones of value-based models, into workflows. Experts have noted a need for “robust clinical risk management” and adjustments to RCM “platforms’ underlying clinical logic, financial template, and codes.” These improvements can help support value-based care’s goal of managing chronic conditions through cost-effective, high-quality care. As these changes unfold, it’s critical that we implement efficient processes that speed up revenue recognition.
Integrate & Monitor Performance Data
Like other aspects of healthcare, data analytics is transforming revenue cycle management. Tracking key performance indicators (KPIs) and trends can help identify pain points and enable RCM teams to maximize their resources and gain efficiencies. For instance, improper monitoring of billing issues can result in denials that cause delayed payments and even decrease reimbursements. KPI dashboards can leverage data analytics to target declining metrics, such as:
- Cost to collect
- Claim-rejection rate
- Days in A/R
- Resolution rate
- Clean claim rate
Furthermore, this visibility can in turn inform action plans to address staff turnover, scheduling errors, and other common issues. Ideally, these insights are easily accessible through your EHR. Centralizing information keeps performance top of mind while avoiding data silos.
Deploy Advanced Training
Without thorough and thoughtful training, even the savviest technology and sleekest workflows cannot reach their full potential. Truly comprehensive training must account for several factors:
- Uniting end-to-end processes. RCM underlies and connects many parts of care delivery and practice operations. Therefore, it’s essential that training highlights not only each role’s unique responsibilities but also their part in the greater whole. This breadth-and-depth approach can help prevent errors and promote a seamless RCM workflow.
- Offsetting workforce shortages. Healthcare’s growing labor shortage can disrupt various stages of RCM. Training and education can help each participant — providers, office managers, staff, and patients — maximize their contribution and create an efficient, effective RCM experience.
- Accommodating hybrid workplaces. Like telehealth, remote work has become a fixture of our “new normal” and will endure long after the pandemic. As a result, training should include digital opportunities to ensure accessibility for all stakeholders, regardless of location.
Partnering with a proven, forward-thinking RCM organization can bolster training initiatives. Having an outside, objective perspective can pinpoint gaps in understanding and areas for improvement. Furthermore, a partnership adds expertly trained man-hours, which is useful amid the labor shortages mentioned above. This added bandwidth and expertise can help support:
- Billing education and resources for staff
- Online learning opportunities for documentation, coding, and compliance
- Evaluation and management (E/M) training to properly document preventive, procedural, and risk-adjustment coding
Beyond training support, a partnership can enable care teams to focus more time and energy on patients. Grand View Research found that outsourcing RCM solutions confers several benefits, such as: “easy availability of trained and skilled professionals, compliance and adherence to required regulations, enhanced efficiency, and cost-effectiveness.”
When evaluating an RCM partnership, look for an organization with a track record of success. Every year, the Healthcare Financial Management Association (HFMA) presents their coveted MAP Award to industry-leading RCM teams that have excelled in meeting benchmarks, implemented patient-centered best practices, and achieved outstanding patient satisfaction.
You can view the HFMA’s list of MAP Award recipients to see which organizations deliver best-in-class revenue cycle capabilities and performance. This “shortcut” can help you find the RCM partner that is right for your practice and patients.