In today’s ever-changing healthcare marketplace, organizational profit margins are under severe pressure. Regulatory changes contained in the Affordable Care Act, Budget Control Act, and the American Tax Relief programs continue to shift payments from fee-for-service to riskier value-based models.
Pressure on increasing margins
Rising patient responsibilities are snowballing into the likelihood of increased bad debt. Declining reimbursement rates from both the government and managed care sectors continue to mount. Inefficient revenue cycle processes often exacerbate these challenges. Manual, paper-based procedures mean that collections and claims processing are inefficient, time-consuming, and often error prone. These ineffective processes result in high costs for hospitals and low satisfaction for patients.
With these ever-increasing pressures, many healthcare institutions are looking for ways to improve their bottom lines. Much of this focus has led to organizations placing an increased value on their revenue cycle performance. However, with all of the options available in the market, how do you know where to start? Is it a need to replace your billing system or a move to a new clearinghouse vendor? Or, will a bolt-on technology solution work best? Selecting the right solution can dramatically improve the efficiency of revenue cycle processes, reduce costs, enhance patient satisfaction—and improve the bottom line.
Consider the solution and platform
When considering your options on how to improve your revenue cycle performance, one consistent theme among revenue cycle management (RCM) executives is consistently sharing information throughout the enterprise. This rings true from both clinical and financial sectors, regardless of the data source and the information format. As a result, where most solutions fall short is that they have not been architected on an enterprise content management (ECM) platform. Moreover, even the newest, most expensive billing platforms consider document imaging and workflow management as secondary requirements within their solution designs.
ECM technology is certainly not new; however, consider deploying that tried and true technology in conjunction with RCM-specific business application workflows. By layering RCM solutions on top of an ECM platform, data and document sharing is solved—and it accelerates organizations forward via a single enterprise level solution for all your business needs. This includes almost every step within the revenue cycle, from the front to the back.
Capture solutions now include everything from data captured via HL7 integration, voice MP3 files, digital photography, DICOM imaging, or computer output, faxed, or scanned images. With all that is available in a single capture, storage, and access platform, the opportunities for business process improvements are virtually endless: built-in functionality of electronic forms, mobile apps, optical character recognition, check-listing, case management, vendor neutral archives, customizable revenue cycle workflows, business intelligence, analytics tools, and more.
A single platform across the continuum of care
Many organizations have existing systems that perform well. They may also feel that they do not have the necessary capital budget, or maybe they are undergoing a merger and acquisition. If a hospital purchases a physician practice, it also acquires its billing system. The hospital may want to allow practices to continue to use their existing applications rather than replacing these systems.
Even if a hospital maintains many systems from different vendors, the right RCM solution can enable it to streamline the end-to-end revenue cycle. An RCM system can deliver a single platform across the continuum of care by integrating and exchanging data across siloed applications. Such a solution can also import correspondence, claims, payments, denials, or other information from systems inside or outside the organization.
Implementing a checklist solution in patient registration, for example, can help ensure that you have captured all documentation for a workers’ compensation claim with automated system checks for signatures and other deficiencies. Further integration with a denial management solution in patient finance can facilitate education and compliance within registration on denial or defect data.
In the not too distant past, hospitals wishing to understand revenue cycle trends once had to enter data into a spreadsheet or task a report writer to create reports. This process could take days or weeks. Such inefficient processes made it difficult for quick, well-informed decision making. Yet many healthcare organizations lack a data analytics solution to improve the revenue cycle.
A purpose-built, integrated RCM solution makes all of the data available in one common repository. Centralized data gives organizations a consistent view of all health data across the enterprise and a single source of the truth. When an RCM solution includes reporting and analytics tools, managers and executives are empowered to use that data to monitor business performance and to make more informed business decisions.
Cost restructuring vs. reduction
These are just a few examples that a single ECM platform with specific revenue cycle workflow automation delivers. However, much of this automation can result in significant labor savings—labor savings that with a cost-restructuring mindset can result in the reallocation of staff to more revenue-generating opportunities.
For instance, what if you could improve a patient account representative’s productivity by even 1-2%? Or, what if you could reallocate three, five, or even 10 full-time equivalent personnel to working down outstanding accounts receivable? The impact to your bottom line can represent millions in savings compared to the fully loaded salary costs of labor, often generating a return on investment in less than 12 months.
Conclusion
Today’s ECM solutions are no longer just the traditional scan, store, and access solutions of the past. They have matured and transitioned into true electronic information management systems that can have a tremendous impact on your organization’s bottom line, especially when leveraging a purpose-built RCM solution layered on top. Selecting the right solution may provide the funds to make a difference, so you can become the acquiring facility—rather than being acquired.
