A high functioning revenue cycle is critical to operations in healthcare organizations. But successfully implementing and sustaining one can be a tremendous challenge. According to HFMA, only 18% of revenue cycle management (RCM) executives rate their current program performance as excellent, and many continue to battle inefficiency despite improvement efforts.
Bottlenecks in coding and billing can cause discharged, not final billed (DNFB) levels to rise, strangling cash flow. Undertrained, overworked staff are prone to make coding errors. Clinical documentation integrity (CDI) failures lead to costly rework and lost revenue while opening organizations to liability related to inaccurate billing.
The role of revenue management consulting
Consultative services have emerged as a tangible solution to address stagnant RCM problems ranging from staffing to process inefficiency. “When you've had processes in place for a long time and don’t see any movement, that’s when you bring in consulting,” says Charlene Beal, business manager of acute care consulting services at Solventum.
Operational excellence can help remove waste and reduce errors. An external expert can bring perspectives gleaned from solving a wide range of problems and apply them to an organization's particular situation to achieve that excellence.
“Our Solventum consultants have experience working with organizations across the globe,” Beal notes. “We make recommendations and work with customers based on detailed assessments of workflows, policies and procedures.”
At times, RCM leaders may know how to streamline operations but struggle to get all stakeholders on the same page. External expertise may be necessary in these cases: a consultant can refine ideas and help build a solid business case around changes. “If an HIM director or vice president of revenue cycle can’t get buy-in from the c-suite, they will often see action happening once we come in and make best practice recommendations,” says Jason Burke, vice president of revenue cycle solutions at Solventum.
Leveraging data and technology
Healthcare organizations often track massive amounts of data. Most organizations have all the data needed to highlight change opportunities, from medical records and billing information to operational metrics and compliance data. “It’s the expertise and systems to apply it to that can help drive change,” emphasizes Burke. “We look at information in unique ways and build actionable analytics. The data tells the story, but you must act on it. Our experts can recommend how to apply the actions.”
Artificial intelligence (AI) has opened a world of possibilities for process optimization. New applications are developing rapidly, with the global AI market in the next few years.
With a dizzying array of options, a swamped RCM executive may not be aware of the range of solutions available. Consulting can help organizations improve and identify new technology for the best return. “We assess provider organizations’ existing technology workflows and mend gaps,” explains Beal.
Enhancing clinical documentation
CDI is critical to accurately capturing the charges associated with an episode of care, but documentation errors are still rampant. According to research, 20% of clinical notes contain errors. CDI teams may struggle to get physician and leadership to buy into their efforts to streamline processes and communication. Moreover, documentation requirements and coding standards change often and vary between insurers.
A consultant with their finger on the industry pulse can help RCM leaders keep up with changes and find paths to improved documentation accuracy. “Each patient’s visit is a chapter in the novel of their care,” Beal says. “We make sure the documentation tells the complete story. Customers and programs have achieved clinical documentation excellence by streamlining processes and people. Providers are engaged and actionized, and teams respond to CDI and coding queries promptly.”
With clinical documentation excellence comes fewer denials, leading to a significant return on investment. Providers spend around $19.7 billion fighting denials annually. It’s a cost that organizations are keen to avoid.
Staffing solutions for revenue cycle management
Revenue cycle staff are difficult to recruit and just as challenging to retain. Business operation support staff, including certified coders, have a 33% turnover rate — around 10 times the national average. Organizations are feeling the pinch. According to the HFMA, 30% of RCM executives are experiencing significant staffing challenges.
The right external partner can help organizations navigate personnel fluctuations to bridge staffing gaps, especially if an organization loses an internal employee with vital expertise. These losses can disrupt the revenue cycle and lead to bottlenecks as organizations scramble to fill open positions. “It has become routine for me to receive calls from panicked CFOs facing increased DNFB. They need help. We offer long-term and short-term supplemental solutions for customers experiencing workforce shortages,” Beal reports.
The right partner can match the staffing solution to a specific organization’s needs, when and where needed.
“Solventum has the flexibility to place staff where you need them for varying periods. It might mean filling a position for a month or a permanent placement. And we offer turnkey total CDI and coding programs with staff ranging from directors to coders,” Beal says.
Organizations working with a partner may even discover a wider range of coverage than they have had before. “We fit our customer’s budget with domestic and offshore resources. And, with time differences, we can offer coverage 365 days of the year, 24/7, and that includes holidays,” says Beal.
Revenue management consulting can transform your revenue cycle into a high performing asset. With emerging tools and expert guidance, you can overcome inefficiencies, recoup lost revenue, solve staffing shortages and reduce errors. RCM leaders who partner with the right consultancy will improve cash flow and enhance operational efficiency to gain a competitive edge in the industry.
