Our ongoing surveys of the healthcare environment have provided feedback from over 150 healthcare systems across the spectrum – general practices, specialist practices, acute care, behavioral health, substance abuse – and more than three-quarters identify the revenue cycle as their most pressing non-clinical challenge.
Revenue cycle management is complicated and undergoing externally driven structural change – creating enormous strain on the department and challenges for financial leadership. The degree of adaptation required while simultaneously servicing the growing volume and complexity of day-to-day transactions has become overwhelming.
Adding more people can help with the workloads, but it’s a temporary fix, and expensive. That’s one reason outsourcing is tempting – hand over this intensive process to a specialist and more cost-effective organization and be done with it. But this is also a risky fix. First, you can’t hand off a strained complex business process without the risk of creating a huge mess. Shifting your work to an outside party requires clear demarcations and precisely defined transactions. Secondly, who wants to hand off the financial heart of their business to an external entity? No-one, if it can be avoided.
Many revenue cycle departments are benchmarking their current state to help sort out where improvements must be focused, such as percent claims denied and billed versus collected revenue AR splits. These are good practices (after all, you can’t improve what you can’t measure), but they do not illuminate many other factors such as revenue that should’ve been billed but wasn’t.
Modern data intelligence technologies are changing healthcare, so why not the revenue cycle. The goal is simple: achieve a significant reduction in outstanding and denied payments, revenue leakage, errors, and overhead.
To explore how it’s helpful to begin by framing the cycle and identify your hotspots. If you’re reading this, I’m certain you’re intimate with this process, and it would be great to hear from you regarding your thoughts on the nuances of your RC process.
By framing the cycle, I mean “follow the chain of events from the clinical encounter to payment”. Successfully implementing an effective strategy relies on developing a cohesive framework for management. This is a great place to start exploring ways to improve your process