3 Strategies for Revenue Cycle Management Optimization

Workflow automation

The healthcare revenue cycle is ripe for automation. As part of revenue cycle management, team members perform many highly repetitive tasks (e.g., eligibility verification, claim status follow-up, and patient statement creation) in order to get reimbursed accurately and quickly. But technology can be used to automate these types, freeing up team members to focus on more value-adding, complex tasks.

Key-Whitman Eye Center in Dallas, Texas has leveraged automation for this reason. The specialty practice recently automated aspects of accounts receivable (A/R) management.

“You have your practice management system, and you have all of these thousands of claims sitting out there. Trying to determine which ones need attention and which ones don't, it's a very manual process going through those,” Matt Chapman, revenue cycle director, recently explained to RevCycleIntelligence.

“We were able to improve, using this software package, our ability to organize claims in a way that maximizes the efficiency of our A/R staff, and I was able to, at that point, begin tracking their productivity,” Chapman said regarding the practice’s implementation of RCM automation software.

The software allowed Chapman to create queues for staff, which in turn led to a 38 percent decrease in A/R over 60 days within the first three months.

Workflow automation on the front end of the revenue cycle has also helped practices during the pandemic. For example, South County Urological in Missouri had automated patient financial clearance prior to the pandemic but once COVID-19 did hit, officer manager Theresa Hammack said the tool was a game-changer.

By automating the process, the practice was able to clear patients days prior to an appointment. This eliminated the need for unnecessary contact, especially during the days of no contact, and in-person check-in when telehealth took over.

“The biggest thing we learned is that we really should have done something like this a long while ago,” Hammack told RevCycleIntelligence.

Front-end optimization

Optimizing front-end revenue cycle processes can reduce headaches on the backend. This has been especially true for Goshen Health. Patient access is key to revenue cycle management success at the Indiana health system.

“From the patient’s perspective, we are the first interaction for their visit,” Sue Plank, director of patient access, said in a recent interview. “We have only one chance to make it an exceptional experience. How the patient experiences patient access can impact the remainder of their visit.”

“From the hospital’s perspective,” Plank continued, “our ability to enter the correct insurance, verify accurate demographics for the patient, and collect the patient’s financial responsibility at the front end all reduces rework throughout the revenue cycle, and ultimately reduces potential denials.”

To optimize this front-end process, Goshen Health has focused on modernization. About 30 percent of health systems rely on manual patient access workflows. But as patients become more computer savvy thanks to smartphones and technology advancements, patient access is tapping features like automated and bi-directional communications to streamline the process.

Additionally, health systems like Goshen Health are seeking to streamline workflows like registration, especially after the COVID-19 pandemic.

“Engaging digitally with our patients for patient intake has allowed us to offer contactless registration to our patients, which is safer for the patient and our colleagues,” Plank said. “It allows them to verify their demographics, take a photo of their insurance card and photo ID, as well as read and sign their consent digitally, all at a time that is convenient to the patient.”

Find a partner

Revenue cycle management optimization can be a daunting task, especially for smaller healthcare organizations. Physician practices do not always have access to capital, technology, people, and other resources to dive into an end-to-end optimization project. Additionally, rapidly growing organizations may find themselves with a patchwork of revenue cycle processes and technologies that can impede enterprise-wide management.

For some organizations, these can be signs that a partner is needed. Revenue cycle management outsourcing has become increasingly popular as a solution to common revenue cycle challenges, such as slow reimbursement, inefficient workflows, and lack of technology.

Coming out of the COVID-19 pandemic, outsourcing is likely to see another surge. The pandemic has exacerbated talent recruitment and retention. Internal revenue cycle management teams may not be a possibility or cost-effective for some organizations right now. This was the case at Tucson Gastroenterology.

“Some people had been there for a long time, like 19 years, and they were retiring and moving on,” Julie Wester, contract administrator, said in an interview. “We were losing some key billers that had known the practice and were leaving in 30 days times.”

The specialty practice in Arizona decided to outsource to a third-party revenue cycle management company. Now, the practice is seeing internal operational efficiencies, as well as increased transparency into its billing practices, Wester said.

However, revenue cycle management outsourcing has not been for everyone. About a third of providers have regretted their revenue cycle management outsourcing decision because of dissatisfaction with their third-party vendor.

For a success partnership, Wester advised other practices to consider a vendor’s knowledge of their specialty, its integration with existing systems like EHRs, and its support system.

 “It’s really important that we have an advocate, a specialist, who knows this site and can answer questions because one of the most frustrating things is if a key player can’t answer questions and you get routed to a 1-800 number. To me, that’s the least effective way,” Wester said.