5 recent RCM tips

Here are five revenue cycle management tips from industry experts, published by Becker's Hospital Review since May 7.

1. Susan Eilman, a senior revenue cycle transformation healthcare consultant at Hayes Management Consulting, shared these seven tips for overcoming revenue cycle system implementation challenges.

  • "Revisit and document workflows with the new system incorporated. Often implementations do not document the actual workflow and miss important factors with processes.
  • Offer refresher training for staff who are struggling with the new system.
  • Develop competency evaluations for all staff (including management) to ensure they all understand the new system and workflow changes. Retrain staff who do not pass with a grade of 80 percent or higher.
  • Update or create new policies and procedures that accommodate the implementation and communicate them to staff.
  • Set up monthly key performance indicators, trend reports or dashboards that will assist in monitoring trends to locate new issues.
  • Create sessions with different departments so they can learn from each other what works and what does not.
  • Hold organization functions to reward staff after implementations are live and show appreciation for hard work and acceptance of new system changes. Communicate positives and outlooks during the functions to encourage joy in the workplace."

2. "To truly understand the origin of your [claim] denials requires periodic tracking of progress on your back end. Say you start with an issue that caused 20 percent of your claims to be denied. If, after deploying significant man hours on a front-end remedy you're still at 19 percent denials, something is wrong. You'll never know what's working and what isn't if you don't pause for a moment and look back. Scheduling project reviews at set intervals after the project go-live will ensure that your goals are being met." - Kenneth Miller, senior revenue cycle management specialist at Cantata Health

3. Charles "Chuck" Duva, MD, CEO of DuvaSawko Emergency Medicine Billing, shared these three monthly reports that practices should run:

  • "Rolling Accounts Receivable Aging Bucket — Your billing department should be diligently following up on the denials, and should be able to let you know which types of denials are affecting your collections and cash flow the most.
  • Rolling accounts receivable by payer per provider — This is the most efficient way to track monies due from secondary and tertiary commercial payers as well as the patient responsibility portion of your claims.
  • Trend analysis of dollars collected per relative value unit per payer — ensures proper payment per contracts for commercial and government carriers."

4. "By leveraging [blockchain and advanced artificial intelligence algorithms], healthcare organizations can deliver both a retrospective and prospective view that can help improve operations and outcomes — all while ensuring the ultimate in compliance and meeting applicable reporting requirements.

Distributed Ledger technology, with its smart contracts, enables providers and patients with a real-time explanation of benefits, which allows for evaluation of targeted patient financial programs to cover higher cost services — giving patients affordable payment options and providers, rapid and accurate reimbursement for services provided." - Deepti Sharma, director of product management at HSBlox

5. "By pre-determining eligibility and practicing time-of-service collections, providers can maintain a healthy cash flow. Coach front desk staff to verify patient eligibility with the insurance company the day before the appointment and to scan patients' insurance card and ID when they check in. If there's an issue with ineligibility, the front desk staff can leverage approved scripts to ask the patient to call the insurance company right then, have them pay their copay or deposit up front, or reschedule for a later date when the issue is addressed. Today's patient is also today's payer." - Tom Romeo, general manager of healthcare IT at Quest Diagnostics

 

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