Want to Maximize Rev Cycle Efficiencies? Here are 3 Considerations

It is no secret that a growing number of healthcare professionals are seeking to do more with less. Whether the phrase ‘do more’ pertains to seeing more patients, retaining more staff, expanding the organization’s technology stack or bringing more dollars in the door, it’s not uncommon for professionals to want to maximize their resources amidst a market influx. Revenue cycle workers especially are feeling the heat as margins continue to reel from pre-Covid levels. 

A recent hospital flash report from Kaufman Hall found that while September ‘24 data showed relative stability, expenses are still high. Experts recommend organizations seek to find new ways to diversify revenue streams by including ambulatory services like surgery centers and specialty pharmacies in their service mix. If you’re like most other revenue cycle management (RCM) professionals looking to maximize efficiencies at your organization, read on for my three considerations. 

Consideration #1: Remember that cash in the door is cash in the door

One of the biggest observations I try to impress upon new RCM customers is to not let more cash be the enemy of any cash. What I mean by this is that it’s easy to get hung up on chasing the higher dollar claims, when in reality you could be focusing on the claims that will get you paid in the shortest amount of time. Sure, while a $5 claim isn’t nearly as appealing as a $10,000 claim, you have to consider the time being spent to get that claim closed. Depending on the complexity of the claim, the days from date of service to final payment can be anywhere from 30 to 45 days – and that’s just on average. Claims with complex codes or prior authorizations might take much longer, leaving specialists to haggle back and forth with payors for months on end. 

If you are finding that your organization is facing tighter margins than usual when it comes to closed claims, it might be worth stepping back and seeing where the bottlenecks are. Coding errors, untimely filing and lack of information are just some of the causes for claims getting denied. While it’s natural to want to point blame on the payor, it’s important to work with your teams and see where the hangups persist. Look holistically at the entire inventory, staff for what you can, and let automation tools present you with a daily overview of what claims will get you money in the door in the shortest amount of time.

Consideration #2: Don’t just focus on technology.

If you’re solely relying on technology to solve all of your revenue woes, you’re setting yourself and your team up for failure. Over the past 15 years of working in healthcare, I’ve found that the biggest indicator of success is a careful orchestration of people, processes and technology to deliver the most value. Most of the RCM leaders I know have experienced what I call “technology fatigue,” and are overwhelmed with the sheer magnitude of offerings out there.

Instead, the market needs to recognize that RCM leaders are extremely focused on tactical objectives on a day-to-day basis to manage their organizations, and there’s no silver bullet. Instead, there’s a growing need for partners on the tech side who can successfully deliver a strategic mix of automation and human finesse to problem solve. AI might be able to do 80-90% of the work, while the remaining 10-20% needs human touch. The key is being holistic about it, and recognizing that it’s not an either/or approach.

Consideration #3: Be willing to scale. 

I truly believe that one of the biggest reasons our company has had the success and growth we’ve had over the years is due to willingness to scale. Success doesn’t come overnight, and that’s true for any business–but with a solid playbook focused on driving customer value, it’s possible to maximize efficiency while applying the same tools to different areas of need. 

Take for example our company’s approach. For years we have worked closely with small physician groups, sometimes as little as 5-10 people on staff, and used our point solutions to drive value for these organizations. By bringing together the right people, the right technology and the right processes to drive change, we’ve been able to scale our business model from an organization that primarily focuses on the ambulatory market to acute care as well. We figured out that the same tools that work for 5-10 physicians can be scaled easily. It all comes back to knowing our customers and being willing to grow with them.

In closing

The considerations outlined above can also be true for your organization. Tools and processes that are efficient at the front of house can also work for your teams in the back-end of the revenue cycle. Do the work of educating yourself and exploring what your organization needs to be successful, and as those needs grow so will your area of opportunity.

Photo: abluecup, Getty Images

This post appears through the MedCity Influencers program. Anyone can publish their perspective on business and innovation in healthcare on MedCity News through MedCity Influencers. Click here to find out how.