How to Simplify Concurrent, Revenue Cycle Improvements

On the heels of the HFMA ANI expo and show, where thousands of vendors presented new and invigorating concepts for finance and the revenue cycle, an article in RevCycleIntelligence.com, spearheaded by Nalin Jain, Delivery Director of Advisory Services for CTG Health Solutions, provides insight on how to simplify many ongoing RCM improvements.

“Whether you call it revenue cycle or protecting your reimbursement, success will depend on making  many improvements simultaneously. It’s not just one small thing that you fix, but making several improvements and making them simultaneously through the process from pre-care to zero balance.”

According to Jain, providers getting the best results are addressing 5 major categories:

  • Pre-service (e.g., pre-registration, pre-authorization)
  • Process of care
  • Process integrity practices (e.g., charge master, coding compliance, clinical documentation)
  • Billing services (e.g., customer support, collections, follow-up)
  • Administrative services (e.g., contract management, fee schedules, debt collections, managed care contracts, denial management)

Jain goes on to recommend that physician practices and hospitals pay special attention to three broad functional areas: financial, technical, and operational.  The integration of these three areas will help determine priorities and simplify how projects are managed.

Managing the process of simultaneous work process improvements should consider the business models deployed. A centralized vs. decentralized vs. outsourcing vs. hybrid billing models all have pluses and minuses as it relates to the deployment of changes.  One must consider versatility and time to deployment. For example, if a process can be reworked in a few weeks or month and deployed successfully, that is a huge win!

An advantage of targeted efficiency deployments are that they enable the organization to focus on its core competencies (e.g., patient) but achieve major savings, i.e. 30-70%! A good example is Orbograph’s OrboAccess suite.  Several areas which yield major savings include eliminating the manual processes around payments, remittances, and correspondence letters. A recent client actually converted in 6 days.

As we transition into second half of 2017, consider the ramifications of quick, focused changes like these.  It’s called “winning”!  Happy Independence Day!

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