7 key challenges for revenue cycle executives
Managing a healthcare organization’s revenue cycle is complex. Allscripts has consulted clients to discuss the top challenges, priorities, and pressures they’re facing in a swiftly changing market. Below are a few concerns that are critical to a practice’s success and ways practices are addressing them.
Becker's Hospital Review
in collaboration with Allscripts
1. Increased patient financial responsibility
Market trends over the past several years have increased the patient responsibility ratios through higher copay and deductible plans. Given this shift in financial responsibly, practices must consider implementing policies and processes, as well as automation to help drive more consistent patient behavior. Enablement of convenient and efficient options for patients to understand balances, submit payments and communicate with the practice, are a few methods practices have adapted to increased consumerism demand within the healthcare industry. Technology that enables patient consumerism and results in more pleasant and streamlined patient experience will continue to be a major competitive advantage for practices. American consumers want goods and services that are ‘fast and convenient’, as shown in the rise of Amazon Prime and rapid food delivery services. Healthcare delivery needs to adapt as consumers demand it.
2. Growing and aging accounts receivable
It will continue to be essential for practices to work on maintaining a streamlined revenue cycle that focuses on efficient patient and insurance collections, denial management and follow-up. Many practices’ backlogs of patient balances often fall to the wayside, exacerbated by payer denials and general issues such as insufficient documentation, coding omissions, and timely follow-up. Practices which have implemented targeted A/R reduction strategies including past due accounts focus, denial prioritization and root cause remediation typically experience low AR days. Furthermore, practices should consider improving access to financial insights either by adding new technology or maximizing their current technology. Practices should strive to identify financial trends, threshold events and other AR vital signs.
3. Lack of visibility into data
Many practices suffer from a lack of revenue cycle information and insights, while other practices spend many hours each month scrubbing, importing and exporting data into the formats and context they require. The proper technology enables transparency into areas such as physician productivity, staff productivity, denial trends and other revenue cycle metrics which assist in data-driven decision making for improved financial outcomes. Practices which maximize their current technology’s reporting capabilities or layer on an additional analytics technology have generally solved their data gaps and improved in areas such as accurate and complete reporting, denial management and maximized net-collection rates.
4. Staff productivity
It’s not uncommon for healthcare executives to wear more than one hat or have to ask their employees to do more with less. In addition, many practices have limited methods for tracking staff productivity and performance. To top it off, practices endure general staffing issues like attrition, attracting quality candidates and maintaining staff. To solve for a practice’s people productivity issues, many practices have opted to align with a business partner, to either help evaluate staff productivity and consistency or completely resolve staffing gaps and needs. Depending on the practices needs, any partner you consider should promote consistency, automation, workflow improvement and savings. A good partner choice enables your practice to focus on other important areas of the business and on the delivery of high-quality patient care.
5. Everchanging government requirements and regulations
In these uncertain and everchanging times, payers are changing the rules and payment standards. As government and private payors continue to develop and change quality improvement (QI) programs, practices will continue to experience increased pressure, having to balance high quality patient care while ensuring QI regulations are adhered to. Maximizing reimbursement and minimizing penalties is the new normal. Progressive practices have found relief from this increased pressure by partnering with an expert. As an example, as the current pandemic unfolded, telehealth adoption continued to increase, and reimbursement rules continued to change. While telehealth has both helped minimized COVID-19 exposure to patients and provided a new source of revenue for physicians, many practices were challenged with maximizing reimbursement. Practices aligned with an expert revenue cycle partner were able to remain current and educated on these ever-changing initiatives.
6. Healthcare market consolidation
Consolidation in the ambulatory marketplace will continue in the foreseeable future. Both fiercely independent practices and ones considering an exit strategy from the marketplace need to continually look for methods to reduce inefficiencies and cost. Regardless of one’s business strategy, practices need to establish new strategies to remain competitive and to increase the practice’s EBITDA. For example, economies of scale can be achieved by introducing technology or automation of manual processes. Reduction of workflow inefficiencies can be improved via one-time or ongoing consulting engagements. Finally, practices may consider introducing new services lines, which can differentiate the practice and improve the patient experience.
7. Pressure for cost reductions
As with most US industries, healthcare is not exempt from the increase in pressure to reduce cost and increase margins. This puts additional pressure on healthcare executives to make sure their practices are getting completely reimbursed for all services they provide to their patients. Focus on charge capture enablement, denial management efficiency and payor contract compliance, must be at the forefront of their revenue cycle procedures to facilitate compliance and revenue capture.