What keeps revenue cycle leaders up at night? It can run the gamut from drawn out system conversions and meeting compliance regulations all the way to addressing the uncertainty of healthcare reform initiatives and steps to increase efficiency among staff.
Yet there’s also so much more – everything that goes into managing a smooth operating revenue cycle. Revenue cycle leaders look objectively at the cost to collect and operating margins. They analyze solutions and seek competitive prices that drive higher value and return on their investments — technology and employees alike. These topics are going to be different for every leader depending on the size of the organization and the objectives of focus.
Below we look at four of the common challenges that revenue cycle leaders from all different types of healthcare organizations are contemplating while trying to get some shut-eye.
Now more than ever healthcare reform is at the forefront of revenue cycle leaders' minds, and decisions made by the government can have a lasting impact on your organization's future. Leaders are currently investing their time into new options for data analytics and negotiating risk-based contracts with payers. The strategy and vision for the future of healthcare is fraught with challenges.
What have you audited recently? Audits are a great way to evaluate current compliance and best practice performance. Partnering with a firm to complete an external coding audit, for example, will put your organization ahead of the game when it comes to changing regulations that might otherwise be difficult to keep up with, and offers certainty that you’re following the ever-changing rules.
Rise of Consumerism
Patients are taking proactive steps to price out and compare their healthcare options as out-of-pocket expenses continue to increase. There is a new precedent centered around the overall patient experience in which the value of a visit is not measured solely by the outcome of clinical care. Instead, it also envelopes the ease and convenience of the patient financial experience such as availability of pricing information and billing options, along with patient education and service standards.
Are you exploring patient bill estimating technology and prompt pay discounts? The healthcare industry in general is way behind the curve when it comes to offering convenient and clear payment options. Educating patients on their healthcare costs will increase satisfaction and reduce stress levels for revenue cycle leaders and patients alike.
It may feel as though your hands are tied and that there’s only so much that can be done on your end to maximize payer reimbursements and minimize claim denials. There are plenty of opportunities, technologies, and options to make a path for increasing reimbursements. To begin, take a look at the data and decide where to focus resources and what projects need to be prioritized.
How will you deal with diminishing reimbursements, unrecovered collections, inefficient billing technology? The billing process is complex in general and is complicated by the fact that different payers each require different information and formats to process claims. Aside from the option of regularly reviewing and re-negotiating payer contracts, one solution is to invest in extra training for claim follow up staff on your major payers. Expertise in payer requirements such as timely filing guidelines, appeal processes, and general payer policies can save time, hassles and reduce denials and delayed payments. Increasing reimbursements and efficiencies are best for getting a full night of sleep.
Cost and Value of Resources
Revenue cycle leaders expect to get the most bang for their buck, and that includes a long list of interrelated topics that must be considered carefully before being implemented.
The cost of overhead:
Major considerations include:
- physical space and employee-related costs
- education and retention
- implementation and training
Increasing efficiency and effectiveness: This is always an overarching goal, but it's not as simple as it sounds. Identifying ways for staff to “work smarter, not harder” and vetting technology solutions is a good start to improve efficiency.
Opportunities for improvement: Common problems that revenue cycle leaders face also affect the patient financial experience — long wait times, patient confusion regarding billing, website portal issues, and staff training gaps.
What are the specific pain points in your organization’s revenue cycle processes? Instead of looking at all of the opportunities for improvement all at once, make small realistic goals and set timelines to achieve them.
The Bottom Line
When all is said and done, seeing measurable results will improve the quality and duration of shut-eye among revenue cycle leaders. Steps to consider include access to custom reporting with insurance denial trends analysis, creative ways to establish strong front-end practices such as insurance eligibility verification, patient estimates, and obtaining pre-authorization approvals to name a few that were addressed above.
As an anecdote, one of our partners was plagued by a work queue build-up that used to keep him up at night. He outsourced to MediRevv, and we allocated the resources to resolve the backlog. All he has to do is check the queue and move on. Working in lock-step with a trusted outsource partner can go a long way to achieve those measurable results and allow revenue cycle leaders to be able to sleep soundly. Rest assured.