This article was also published by Becker's Health IT and HISTalk.
Today’s economic pressures, changing reimbursement policies, and competition for talent suggest we are never really done improving our revenue cycle management processes.
Studies indicate that focusing on RCM can help reduce the widening gap between higher and lower performing organizations.
This information begs the question: What are the revenue cycle management opportunities your organization should focus on? Consider these opportunities.
Consider circumstances that point to improvement opportunities. Reconsider any processes or solutions that:
- are still accomplished on paper
- involve a FAX machine
- have not changed in the last five years
- are repetitive
- don’t involve peer or higher-level review
- consistently receive low engagement scores
- are not documented
In a 2023 study, HFMA reported on the rising cost of claims with as much as 60% of claims not resubmitted and the average denial rate’s total percentage of gross revenue at 11%. What’s more is they found the cost per claim appealed is $118 and the denial rate is increasing 20% YOY. In an era when budgets are tight and margins are lower, leadership teams need to understand the potential impact of improvements, your improvement efforts, and your progress.
Make reporting work for you. The best RCM decisions are made based on actionable data. On average, healthcare organizations leverage around 30 different vendors across the revenue cycle. Disparate data sets complicate clear actionable reporting and limit the ability to see patterns and identify areas of opportunity. RCM leaders need effective reporting and road mapping tools to tell their story, presenting a fresh vision around the use of technology and resources and the impact they can make.
Consider important processes up and downstream from revenue cycle. From patient access, financial clearance, provider documentation to discharge and final payment for services, RCM processes run through the entirety of a patient’s experience and involve touchpoints with all the departments that a patient’s care requires. This presents complexity and opportunity for RCM starting with adoption of a unified vision/strategy, change management practices, governance policies, and system interoperability development.
Develop your organization’s technology roadmap. The areas to focus on are a matter of an organization’s current state, their strategic goals, the needs of their community, and their competitive position. Sound revenue cycle management processes can support any endeavor and improve financial performance. In turn, improved financial performance is fundamental to realizing improved quality, outcomes, and more.
The Healthcare Financial Management Association (HFMA) recently released the Revenue Cycle Technology Adoption Model (RCMTAM). The first model of its kind for healthcare, RCMTAM helps uncover opportunities (such as gaps in functionality or low engagement with technology). The model helps develop a roadmap for realizing the impact technology adoption can have on financial performance by addressing those gaps and improving usage.
Consider using RCMTAM framework as a structure to uncover opportunities, determine what’s working and where there are gaps. This model helps you build a roadmap to tell the story of how technology improvements correlate to financial performance.
Stay inspired by the opportunity. Working on improvements to revenue cycle management processes looks and feels like improving cash flow, increasing reimbursement rates, reducing denials, and enhancing overall performance. And all of the above play a part in the delivery of care to the people who entrust their care to your organization. The compassion inherent in pursuit of a unified RCM vision with the support only technology can bring to patient, provider, and RCM staff experiences is often underestimated.
