7 recent RCM tips

Here are seven revenue cycle management tips from industry experts, published by Becker's Hospital Review since Feb. 22.

1. "Predictive analytics and algorithms that leverage data from disparate sources take a tremendous burden off staff and identify opportunities to protect revenue in real time — from the medical necessity of patient cases, to changes in patient status, to which claims are at the greatest risk for denial — all while keeping compliance at the highest possible level.

"Data should be thought of as an asset and a tool, rather than a burden and a constraint. Let your data work for your staff." - Tara Dwyer, vice president of audit operations at Xsolis

2. "The outpatient/ambulatory clinical documentation improvement lens must have the ability to focus on audits to protect revenue and prevent denials. This focus will allow organizations to create clinical documentation that aligns clinical and financial information for more efficient care delivery and reimbursement. Specifically, this lens will guide physicians to document all conditions to the greatest specificity each year so the physicians receive the appropriate reimbursement for the care provided. If quality and accuracy 'gaps' are identified, a variety of educational modalities can be delivered to the appropriate audience (coder and/or clinicians) to improve clinical documentation content and adherence to coding guidelines." - Mark Hendricks, vice president of product management at nThrive

3. "Thanks to our new health information technology platform, which serves all the different components of our health system, we've got visibility that we've never had before into revenue across all of our care settings. Without the benefit of big budgets, it's critical that we have the ability to manage every detail, so we can see where there are opportunities for improvement — this additional insight enables us to quickly identify and resolve any issues that need attention. Overall, the integrated approach of our new RCM solution led us to a near-immediate boost in financial performance: We've reduced our days in accounts receivable by about 10 days, and it is only continuing to improve." - Eric Ritchie, COO of Grantsville, W.Va.-based Minnie Hamilton Health System

4. "To maintain provider enrollment, Council for Affordable Quality Healthcare re-attestation is required every 120 days for each provider. Advances in technology are enabling this process to be greatly streamlined. The ability to set automated reminders and alerts of pending re-attestation dates not only saves time, but eliminates the possibility of providers falling through the cracks." - Patrick Doyle, senior vice president at Newport Credentialing Solutions

5. "One way to keep denials from happening in the future is by stepping away from the manual processing that takes place at a computer terminal, and replacing it with an automated claims and denials system. An automated system has the benefit of knowing payer codes. Treatment codes change over time and must be kept up-to-date. Keeping track of them by hand is difficult and time-consuming, but an automated solution has the ability to keep codes updated by automatically requesting and receiving payer updates.

"Office staff can use the automated system to understand why the denials occurred and make workflow changes to lessen the chance they'll happen again moving forward." - Kevin Lathrop, president of TriZetto Provider Solutions, a Cognizant company

6. "Don't let your analytics solution become shelfware. Over the past several years, there have been myriad analytics solutions available in the RCM marketplace. While these solutions offer promise, it's not a given that each has the ability to deliver on improving operations at your organization. Optimizing resources, improving revenue and managing costs require analysis of vast amounts of operational data. To accomplish this, the ideal analytics solution is one that uses native operational data versus aggregated data.  

"Analytics goes hand in glove with operational improvements when one considers the multivariate analysis required to understand root cause across the organization. Of importance when considering improvement is granularity of information and the ability to leverage data from native sources. Analytics helps organizations understand the levers they can pull to effect change to a process and measure the impact of that change." - Eric Nilsson, chief technology officer of SSI Group

7. "There is true value in enlisting outside help to assess the state of your business operations. Because they are not immersed in your day-to-day activities, their vision is not clouded. When selecting a partner, make sure they have experience running a hospital. Ideally you want a national-level consulting group as they are more likely to know about larger trends rather than only what is going on in your local market." - Kenneth Miller, senior revenue cycle management specialist at Cantata Health


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