What Does Award-Winning Revenue Cycle Management Look Like?

Editor’s Note: This post is adapted from The Break Room podcast episode focused on trends in revenue cycle management and tips to help independent practices optimize their revenue integrity. Listen to the full episode below.

A recent report valued the revenue cycle management (RCM) industry at $126.1 billion and forecasted a more than 10-percent growth rate over the coming decade. Driving this boom is the need for RCM systems that:

• Streamline workflows
• Comply with ever-changing policies and regulations
• Ensure accurate and timely payments
• Keep pace with healthcare’s ongoing digital and technological transformation

In this episode of our podcast, we discuss these innovations and challenges with Melanie Suranto, Vice President of Revenue Cycle Management at Privia Health. Our conversation explores the potential benefits and key criteria of an RCM partner, RCM’s role in building trust in the doctor-patient relationship, the impact of training and technology support, and more.

What exciting technological innovation is happening in the revenue cycle management space?

Melanie Suranto: Part of our mission is to employ proprietary technology that supports a first-rate patient experience. We pride ourselves on having that robust, user-friendly, and streamlined electronic health record (EHR) system in place. We’re surrounded in a world of technology. And when I think about the innovation that is currently in the works outside of looking at how we can continue to enhance our EHR — because that’s always a hot topic for us — we also have, and continue to build, robotic process automation where we can. So, anything that a person has to do manually, and they do that on a daily, weekly, or even monthly basis is up for discussion.

We really aim to reduce manual and mundane processes. Automating credit card refunds and auto-transferring unapplied payments to open balances are newer bots that we’ve implemented. I would also like to add that it isn’t just technology that we’re innovating; it’s also our service offerings, which are becoming more and more important. We now have three new services, CODER+ and BILLER+, that really aim to reduce the burden placed on providers today. CODER+ offers coding and claim-creation services that improve coding accuracy and revenue capture. And BILLER+ takes on claim management to help with reduced denials and faster revenue recognition. So I would say that we’re really innovating both in the technology space as well as the service-offering space.

The Healthcare Financial Management Association’s MAP Award is one of the most prestigious distinctions in the world of revenue cycle management. In 2022, Privia Health received this coveted award for the seventh-consecutive year. What projects, processes, and metrics this specific performance year’s win highlighted?

Suranto: This year’s win highlighted work that we did specifically around COVID, telehealth, the No Surprises Act, and having remote and hybrid employees. One of our big callouts was the National COVID-19 Workbook that we put together. With COVID, we faced a new challenge of payer criteria evolving at a rapid rate with tons of variability that we had to account for. New policies were being launched left and right. That not only included COVID treatment, but also telehealth changes and regulations. We needed a centralized location to store and track information. We had so much information coming at us from every angle that, in order to stay on top of it, we started with our coding team, identifying the impact of COVID and telehealth codes.

Then we deployed resources to start collecting payer-specific information and gathering that information in one place. Once we had enough information to get started, we started sharing that with all of our providers and Care Centers throughout the nation using newsletters and webinars, which was very well-received. Having a centralized location that served as an extensive resource tool of everything we knew (and even the things that we didn’t know that we were still researching) was essential in managing the RCM process. For our Care Centers and providers, it was like having a “phone-a–friend” lifeline available 24/7.

With COVID, we faced a new challenge of payer criteria evolving at a rapid rate with tons of variability that we had to account for.

We already had remote and hybrid employees in place for years, so we were easily able to adapt to a fully remote environment. This allowed us to provide consistent and reliable service to our providers and our customers during those uncertain times. To ensure that our team stayed close, we implemented weekly RCM touchbases, which helped to ease everyone’s mind, provide a forum to answer questions, and allow our non-remote employees to remain connected. We also partnered with our analytics team to specifically look for trends that we needed to stay on top of from a performance perspective so that we could remain operational and viable.

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