For many — if not most — healthcare providers, collecting patient demographics, insurance information, copays, and deductibles prior to performing procedures is a highly manual process that involves multiple touchpoints between staff, payers, and patients. Experienced front-end staff revenue cycle management (RCM) teams work together to capture as much data as they can to support efficient billing for services provided.
Unfortunately, in the post-pandemic era, many RCM teams are still running lean. Over the past four years, some of the most highly skilled medical billers retired or found alternate employment that offered more flexibility. Recruiting new RCM staff can be challenging, with healthcare providers competing for talent against higher paying opportunities in other fields and positions that offer flexible hours or remote work arrangements.
Talent Loss Can Lead to Revenue Leakage
With the departure of experienced RCM talent comes the loss of deep, institutional knowledge. Valuable insight into how a certain payer operates or how specific types of claims get paid more easily hasn’t been documented. All the filing, prior authorizations, and coding nuances that prevent claim rejections and denials were learned through experience — and when the experience walked out the door, it left no one to train the next generation of billers.
With the labor pool as tight as it is, many healthcare providers have had to hire less experienced staff. Less experience can mean more errors and more errors mean more revenue leakage. Staff may not realize that the insurance card presented by the patient is out of date. If the patient’s name or group number isn’t legible on the paperwork, they may enter it incorrectly into the system. They may not know how to look up the patient copay or coinsurance on the payer’s website so they can collect it on the spot.
Whatever the reasons, if patient and payer information are not captured correctly at the beginning of the encounter, the risk of claim denial increases.
Monitoring Key Indicators Helps Diagnose and Treat RCM Problems Early
Inexperience and errors cost time and money. Without good controls in place, revenue loss is likely. To prevent losses, healthcare RCM leaders should track key performance indicators (KPIs) that can identify issues early and direct their team to take appropriate action.
- Accounts Receivable (AR) Aging — As time passes, it becomes increasingly difficult to collect within timely filing and timely appeals deadlines. Aim to keep the percentage of AR over 90 days below 20%.
- Denials Management — Understanding why claims were not paid can help RCM leaders spot and correct problems with front-end workflows, coding, specific payers, or coverage of certain procedures.
- Days Sales Outstanding (DSO) — The goal is to receive payment for submitted claims as quickly as possible. DSO under 30 days is ideal, with up to 45 days considered acceptable.
By monitoring these KPIs, a healthcare provider is more likely to perform financially at or above industry benchmarks. When staff is less experienced or simply overburdened, however, it can be difficult to notice problems or to take the steps necessary to correct them.
Technology Can Boost RCM Team Productivity and Financial Performance
Revenue cycle management (RCM) optimization technology can provide peace of mind, regardless of staff experience and bandwidth. For example, automated solutions for insurance discovery and insurance verification can reduce administrative burden significantly. If a routine insurance search comes back with coverage not found, insurance discovery technology can return the correct plan information in seconds, eliminating the time it would take to make multiple calls to the patient or payer to obtain the correct information.
Consider something as common as looking up a Medicare beneficiary identification number (MBI). This process can take two to three minutes to perform manually, compared to just seconds if using an automated lookup tool. Once a claim has been submitted, the right technology enables RCM staff to review the status of an active claim at the click of a button, as well as to see when payment is anticipated.
There are even centralized, AI-enhanced solutions for prior authorization that streamline tedious processes and can identify requirements based on payers, plans, and groups to determine at the point of care whether the patient meets those requirements. Deductible monitoring technology works in the background and notifies staff when a patient’s deductible has been met — giving them the power to precisely time claim submission to the payer. All of these tools help front office and billing staff work more effectively while reducing the administrative burden so that they can focus on higher-value responsibilities.
Best Practices for Optimum Revenue Capture
Best-in-class RCM optimization technology is an investment that pays dividends in greater revenue capture and a lighter administrative burden for staff. Healthcare providers who want to improve RCM staff productivity and drive optimum revenue capture should follow these best practices:
- Review KPIs and examine manual RCM processes.
- Identify opportunities to leverage technology to improve the quality of patient and payer data and to reduce or eliminate administrative burden.
- Evaluate and implement one or more automated RCM optimization tools, including:
- Demographic verification
- Insurance discovery
- Insurance verification
- Deductible monitoring
- Prior authorization
- Claim status
Manual RCM processes are costly, error-prone, and unsustainable in a lean healthcare operation. Technology that supports RCM workflows by automating and optimizing the collection and management of patient and payer data contributes to healthy financial performance, regardless of staff’s level of experience. These solutions quickly pay for themselves by boosting productivity and generating more revenue faster without increasing head count. At the same time, relieving staff of some of their more onerous administrative burdens can contribute to retaining good people and keeping operations flowing smoothly during prolonged staff shortages.
About Us
ZOLL AR Boost is the comprehensive, revenue cycle management optimization solution suite that automatically finds, corrects, and verifies patient and payer information. It helps healthcare financial teams capture more revenue, reduce administrative burden, and improve the patient financial experience. The solution delivers accurate, actionable data to reduce claim costs, drive self-pay and high-deductible conversions, and improve revenue collection compliantly. ZOLL Data Systems provides software and data solutions that help RCM teams and healthcare providers improve financial, operational, and clinical performance.
