Revenue cycle teams are critical to the financial success of provider organizations, as they determine patient eligibility, enter required billing data, collect patient co-pays, code claims, track claims, collect payments and follow up on denied claims. If one member of the team does not adequately perform their task, it can mean significant revenue losses for the organization.
But some healthcare organizations struggle to recruit, retain and develop skilled revenue cycle staff for project management, clinical documentation improvement, coding development and other essential revenue cycle functions.
The root of the problem
Many revenue cycle roles are viewed as clerical or administrative in nature, and pay for these positions tends to be comparable to other clerical jobs, says Sondra Akrin, vice president of revenue cycle transformation at Hayes Management Consulting.
However, many revenue cycle positions at healthcare organizations require a greater skill set than typical clerical or administrative roles.
"Whether they're at the front end of the revenue cycle like checking in patients, or the back end in the business office; these roles have to understand a multitude of payer requirements and the flow of the revenue cycle. They have to understand their customers," says Ms. Akrin. "But what we see is a lot of organizations not valuing the complexity of those roles. They need to compensate them accordingly to retain and attract people to these roles."
Perform a pay grade and benefits analysis
To address this issue, Ms. Akrin encourages healthcare organizations to do a pay grade and benefits analysis. However, her advice comes with a caveat: Front-end roles may not always be well-defined and easy to compare with other front-end definitions within the market.
The front-end staff is a little trickier because those who are part of the revenue cycle team at larger organizations may do only a handful of repetitive tasks, whereas at smaller organizations, they may have more on their plate. Comparing the compensation amongst back-end revenue cycle roles is typically easier, as those roles are more defined and, for the most part, are consistent across the healthcare industry, Ms. Akrin says. "The definition of roles in the business office are fairly consistent in definition, but with front-end staff, it's harder to find the right compensation package for them compared to their peers."
Ms. Akrin says performing this analysis is especially beneficial in competitive markets. She cited Medical Row in Houston, where many of the big local healthcare organizations are on the same street. It's easy for employees in Medical Row to take another job at an organization down the street, since they aren't changing their commute or geographic location. "So hospitals with a heavily concentrated, competitive market should be doing a pay grade and benefits analysis to compare where they can stay competitive," she says.
Get creative with incentive packages
Ms. Akrin also encourages hospitals to get creative with incentive packages for RCM staff, rather than solely focusing on the dollar amount per hour or the benefits package. In her experience, healthy organizations get inventive in offering bonuses and incentives to front-end staff and recognize they are the gatekeepers of the revenue cycle. "They're essentially starting the revenue cycle. They're putting in registration information. They're doing insurance verification. With all that work not being done on the front end, the business office would have to do so much clean up on the back end," she says.
To recognize the important role of the front-end staff, some organizations have shifted to an incentives model where they reward front-desk staff for performance, according to Ms. Akrin. For instance, an organization may reward front-end staff for doing a great job of collecting money up front. The reward may be a monetary bonus or profit-sharing that shows the organization values the work that staff member is doing.
Some hospitals are also incentivizing front-end staff who do a great job of verifying information with the patient, according to Ms. Akrin. "If they, over time, show they have decreased the number of denials, rejections and edits that were occurring, that person should also be recognized for their contributions to the revenue cycle efficiency," she says.
Leverage training in staff retention and skill development efforts
Ms. Akrin says a recurring theme she sees related to employee satisfaction and retention is lack of effective training programs. Not every organization has a deep, skilled resource pool to recruit from. Hospitals in rural areas, for instance, typically have a limited market to pull from compared to hospitals in urban settings.
Since many rural hospitals don't have a robust healthcare-savvy pool to recruit from, Ms, Akrin advises these organizations to focus on certain soft skills, such as good communication. She also recommends looking for someone who is very technically savvy or who has held customer-facing positions in the past. Hospitals and health systems can leverage their strong training and staff development programs to overcome what these employees may be lacking when it comes to healthcare knowledge.
But Ms. Akrin did note training must go beyond the basics. "I think sometimes training gets reduced down to systems/technical training like how to register a patient or log in to a computer system. But they really miss the other side of that which is you need to explain to people what the revenue cycle is from start to finish, cradle to grave, and help the staff understand their specific contribution in that role to the revenue cycle stream," she says. "Otherwise, if you don't explain that to them, they don't understand that when they let something fall through the cracks, it hurts the revenue cycle downstream and it creates a lot of inefficiency, revenue loss, delay in revenue recognition, etc."
Bring in a third party
In addition to developing skills in-house with a training program and doing an analysis of pay, healthcare organizations need to be looking at alternatives for staffing. Generally, exploring opportunities to overcome a temporary or permanent staffing gap are beneficial, according to Ms. Akrin. Those opportunities include bringing in a third-party resource to help the organization staff some areas where there are gaps. These third-party resources may include temporary agencies, accounts receivable outsourcing companies or a consulting firm.
St. Luke's Hospital's efforts to recruit and maintain skilled RCM staff
Ms. Akrin's advice is manifested at Chesterfield, Mo.-based St. Luke's Hospital, where officials have made changes to RCM staffing based on the complexity of roles, and leveraged training in staff retention and skill development efforts.
To overcome competition for clinical documentation improvement specialists and coding personnel, St. Luke's has changed its staffing model related to coding, says Lisa Dille, director of health information management at St. Luke's.
The hospital separated the types of coding roles that require a high level of expertise and credentials from the basic coding roles. "This has allowed us to open up positions to a broader range of potential candidates and fill previously vacant positions," she says.
The hospital also implemented a coder fellowship program where it brings in local health information management students and new college graduates to help them learn and become qualified coders. Ms. Dille says this allows the organization to cultivate additional coders.
In addition to these efforts, which have helped with recruiting, St. Luke's also offers tuition reimbursement to certain employees who are interested in going back to school to learn coding, says Ms. Dille.