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3 tips to optimize rev cycle efficiency

Strengthening rev cycle efficiency is tough. And there’s no denying how costly that can be when it comes to healthcare’s complex billing processes. Just take a look at some data provided by the Centers for Medicare and Medicaid Services (CMS).

  • In 2017, national health expenditure accounted for 17.7% of gross domestic product
  • Health spending is projected to grow an average of 5.5% each year to reach nearly $6T by 2027

In addition, healthcare facilities in the United States currently stand to lose about $364M in reimbursements

Despite today’s costs and the anticipated forecast of additional spending, quality of care still suffers as providers struggle to manage expenses and make the right investments.

But there is a solution. After years of working with healthcare organizations of all shapes and sizes, we’ve gained invaluable insight into how the best and brightest are responding to a market seemingly designed to reduce the revenue you earn per patient.

Three tips to maximize rev cycle efficiency

1. Track claims throughout their entire life cycle

Claim submission isn’t just a one-and-done process. It requires having the right data on hand at any given moment so you can see exactly where you went wrong (and fix the error for next time).

Industry experts estimate 90% of denials are preventable. Yet in 2017, health systems wrote off 90% more claim denials compared to the six prior years. That’s a $3.5 million loss over four years. That’s why you should quit relying on inefficient processes to fill an important part of your revenue cycle.

Instead, make sure you have technology to support your staff.

Look for purpose-built intelligent automation that can pinpoint your issues in real time, leading you to the next best action before you need it and allowing you to troubleshoot errors throughout the entire process to keep that claim moving and ensure you actually receive payment.

2. Reallocate jobs for staff specialization

Requiring staff to handle the brunt of the repetitive, manual, and time-consuming work billing requires is a burdensome and costly task for an already overworked department. And while robots won’t replace providers, bots embedded in software applications can be a key tool for reducing the burden of mundane, common tasks.

Staff should work where they excel. Sending categorized claims directly into work queues allows employees to become specialized in their work lists, either by payer, plan type or reason for denial.

Automating repetitive manual processes allows employees to have time to focus on meaningful conversations with patients. And since conversations create relationships, relationships create trust, and trust ensures that everyone is satisfied, patients feel engaged and supported, and you actually get paid.

3. Alleviate your claim backlog

Many claims require manual intervention during at least one point of their lifecycle, making an employee’s main challenge determining which claims need attention and when.

Rather than forcing staff to spend their limited time sorting through endless data, you need a logic engine that reviews, standardizes and catalogues all payer reason codes on a claim to identify what is required within your HIS, give staff easy-to-understand updates and reduce accounts per work-list.

Your system should know when it’s time to recheck a claim based on configurable days (like the routine amount of time a payer takes to adjudicate or the days since a particular status).

The Wrap Up

There is no magic bullet to solve your RCM problems. While there are many technologies that will help, you must judge what works specifically for your organization and your goals.

Maximize technology where it makes sense to do so. Develop strategies that enhance staff’s ability to do their jobs well. Leverage data and insights to make sure you’re doing the most with the information you’re given. Put all those pieces together to create realistic goals that will help your revenue cycle processes run more smoothly. And then push to actually achieve those goals.

Looking for more tips on how to strengthen revenue cycle efficiency? Check out Waystar’s insights and resources page for even more tips and strategies.

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