With technology, new revenue cycle management challenges arise

Long gone are the days where professional medical coders and billers pulled medical insurance claims off the typewriter and stuffed them in an envelope to be mailed for payment.

While technology has ushered in speed and efficiency to the revenue cycle management process, with it has come expanding complexities that providers and healthcare organizations must navigate to pursue payments for services rendered.  

Developing streamlined workflows across broad processes with multiple integrated  systems, coupled with payer billing requirement complexities, poses major challenges  in the collections process. In addition to workflow and process challenges, a lack of usable  comprehensive data and actionable insights makes pinpointing and resolving inefficiencies  and financial leakage more difficult. How are providers and health organizations tackling these  issues to promote patient care, ease the pursuit of payments, and gain more visibility into their  operational and financial health? 

Efficient workflows and processes are crucial to driving value for healthcare providers and health  organizations. Providers and organizations are now leveraging a broad scope of integrated systems to  deliver care to patients. Adoption of scheduling, verification/eligibility, electronic health records,  charge capture, billing platforms, and financial management systems permeate through the  healthcare landscape regardless of size or specialty. The Center for Medicare and Medicaid Services  (CMS) has gone as far as to implement an incentive or penalty for the adoption or non-adoption of  electronic documentation and patient care tracking measures.  

A recurring theme for organizations is that many of these workflows and processes become  segmented throughout numerous departments or vendors, often creating inefficiencies, as well as  costly and complicated workflows impacting their bottom line. 

Developing and implementing solid workflows will promote efficiencies, but providers and health  organizations want to see the benefits within each segment. Implementing workflow metrics to ensure  operations are running smoothly serves as a canary in the mine when they aren’t. Reconciling charges  to appointments within 48 hours will ensure timely claim filing for 100% of appointments. Posting all  payer payments/remits within 48 hours ensures all patient accounts are up to date and cash is being  reconciled and booked numerous times per week. Denial follow-up within 10 days of receipt with an  overturn rate of 95% or higher helps to maximize net collections in a timely manner. Among other  workflow metrics, these are crucial areas to monitor for any lag, inventory build-up or staff training  needs. When issues or lags arise in the billing, posting, or AR follow-up process, established workflows  must be able to identify and address them as timely as possible. 

With scalability, business continuity, and profitability in mind, providers and health organizations are  looking to partners in the industry with the expertise and capabilities to provide guidance, develop and  manage streamlined cost effective workflows, and compliment growth strategies.  

As more systems are integrated and utilized within a health organization, standard/uniform data sets  and the ability to analyze data across multiple platforms becomes a major hurdle. The aggregation and  maintenance of data across a number of systems becomes a costly endeavor for providers and  organizations. As a result, there has been an increased desire to partner with companies that have the  capability to ingest large and diverse data sets and transform them into meaningful insights.  

Custom reports and dashboards that help drive workflows, as well as trended financial information, are  highly sought after to help identify inefficiencies and tell the financial story over time. These data  insights are aimed at delivering the best level of care to patients, driving operational actions to improve  efficiencies and reduce costs, and ultimately reduce time-to-cash to less than 45 days while achieving  95% or greater net collections. 

One-size-fits-all solutions are not commonplace, as the operational landscape and technology  utilization and capabilities differ from one organization to the next. Care providers and health  organizations are looking for partners with diverse areas of expertise and flexibility to provide solutions  to a broad range of challenges. Increased cash flow, reductions in outstanding accounts receivables,  operational cost savings, and detailed insights through analytics are among the high-value strategies  many health organizations are aiming for.  

Kurt Anderson 
SVP & GM, Payment Services EXL Health 

Chase Riedel 
Assistant Vice President of Business  Solutions, Provider Services EXL Health 

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