3 Keys to Revenue Cycle Management Success

By Týr Dustin Miranda, CSSBB | Sr. Consultant | August 18, 2020

The foundation of any solid healthcare company revolves around many different things. However, highest among them is proper structure and consistent evaluation. Nowhere in a healthcare organization is this more important than in a Revenue Cycle Management (RCM) department. RCM departments need to routinely re-evaluate their operating structure to stay current with the industry and to maximize efficiency. Your organization can achieve revenue cycle success by regularly auditing and modifying the processes and structure of your department.

With daily, and sometimes hourly, updates on the global health pandemic it is helpful to remember that historically, RCM guideline modifications move at glacial speeds. The current environment of rapid-cycle changes will not last forever and organizations that needed to be flexible will once again gain a sense of stability. Healthcare delivery is an ever-evolving topic in the modern era. Companies who have successfully assessed, analyzed, and planned for a post-pandemic future will be well-positioned to continue succeeding.

In an age of innovation and technological advances, it is becoming increasingly important for RCM departments to consistently reassess their operating structure and workflows. A stress-test for your system helps you spot any glaring holes or gaps that have crept into your operational processes. During the COVID-19 pandemic, many healthcare organizations are facing an unprecedented volume swing in either direction. For organizations who are experiencing a downturn in overall volume, the time to take a deeper look at your operational structure is right now. For organizations who are dealing with the opposite, ensuring that you do not lose sight of these types of reassessments is important. The industry will more than likely stabilize, and those organizations should already have a plan in place to evaluate their processes.

The 3 Keys to a High-Performing RCM Department

Healthcare organizations should evaluate their RCM model to ensure high performance:

  • Process efficiency
  • Structural consistency
  • Opportunities for automation
Process Efficiency

High-performing Revenue Cycle Management departments generally have one thing in common; close oversight on their end-to-end processes. This prescriptive look at their overall processes allows senior executives to see what is working well and what is not. Are the organization’s clean claim percentages not within allowable thresholds? What area within the process is causing this deficiency? Senior management that is consistently evaluating their operational model are able to spot the areas where efficiency can be maximized. This in turn, allows the problem to be solved without evolving into a much larger issue. As we can all attest, revenue cycle management is not a set it and forget it type of work. It takes constant evaluation and measurement to ensure we are making the greatest impact as possible for our client’s organizations.

Structural Consistency

High-performing organizations will also have rigid structures embedded into their system to ensure that the way they work and process their claims is consistent throughout their department. This structural consistency is paramount to the long-term success of any RCM department. Not all of our organizations are fortunate enough to have long-time staff who are intimately familiar with the eccentricities of every payer. More often than not, modern RCM departments are made up of both new and seasoned claims experts. Ensuring that all staff are processing claims in the same manner, documenting in the same areas, and including all relevant information is an integral part of being a high-performing organization. However, each payer or process may require a specialized workflow or process to meet the requirements. Leadership must ensure that they are documenting these specialized procedures so that all staff are aware of their specific requirements. Single points of failure in the RCM world are dangerous so you never want one single resource holding all of the institutional knowledge. Cross-training is key!

Opportunities for Automation

One of the more exciting things happening in the RCM world today is the push towards automation within the claims process. More and more healthcare organizations are searching for opportunities to include automation within their RCM department to assist with the two points listed above. Process efficiency and structural consistency are fantastic by-products of automation that assists organizations in processing higher volumes of claims with lower resource output. A RCM department running at maximum efficiency is truly a sight to behold.

However, technology and cost may be barriers for some healthcare organizations in implementing automation into their processes. RCM leadership should work closely with their finance and IT departments to search for the right type of automation for their specific organization. From there, it will be simpler to calculate the overall return on investment the organization stands to gain from introducing automation.

The Future

Focusing on these 3 areas ensures that your organization’s Revenue Cycle Management department is operating at maximum efficiency. The returns on this focus will be evident in both the short and long-term quality metrics and financials for the organization. And while there is a tremendous amount of uncertainty during the global pandemic, the need for consistent and profitable revenue cycle processes will remain constant. Take the time now to help create a viable and sustainable RCM department for your organization through diligence, analysis, and proper planning.

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