CFO Guide To Smarter RCM Solutions


A CFO’s Guide to Smarter RCM Solutions

Health system CFO’s are facing unprecedented challenges in today’s market. There are extensive strains on margins from supply chain pressures, workforce efficiency and labor shortages, and increased pressure to compress revenue cycle metrics with payers. On top of this, patients own more financial responsibility than ever before, creating yet another complex engagement pathway mandated by regulations with significant patient revenue and margin impact.

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Overall, your mission is to create healthier communities, foster positive patient experiences and tighten the lasting bond between patients and your practice. The financial health of your organization bolsters these goals. However, the frenetic pace of changing business models and technology landscapes are pressuring organizations – and CFOs specifically – to offer swifter, smarter support for their revenue cycle leaders and create long-term strategies to solidify a foundation for operational excellence and growth.

CFOs are likely to pressure their teams to drive higher utilization of their IT assets. And if you are an organization that has invested millions in an electronic health record (EHR) or practice management system, or are part of an organization that has grown via acquisition, it’s important to recognize upcoming opportunities to consolidate platforms and enhance more parts of the revenue cycle.

Are you a CFO looking for a strategic partner to learn about areas of improvement and effective revenue cycle strategies to grow revenue, reduce costs, and drive operationally efficiencies? Check out this checklist to optimize your organization’s success.


Maximize the value of your EHR investment

One of the most important lenses to keep in focus as you look for a strategic partner to support your IT department and your organization’s revenue cycle goals is your EHR system. You’ve already invested significant money into your EHR and don’t want its full capability left unrealized. When you efficiently utilize all workflows and integration points or augment them with solutions to address a business gap, you drive higher utilization of your EHR asset.


The power of picking the right platform

Point solutions can be constrained by a linear and narrow path. Often that demands an expense that’s hard to ignore. Even with a simple scenario for a health system or hospital’s revenue and payments cycle, there can be over 20 separate yet vital business operations, all of which will need some kind of software solution. Platforms can reduce operational and overhead costs in the long run and better connect data and information with the user experience to yield better outcomes.

A revenue cycle platform should have solutions that cover services from pre-visit, patient access and financial clearance through to mid cycle coding, billing and claims management, adjudication, appeals and patient payments, just to name a few key areas.

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Future proofing + reduced investment churn

IT roadmaps are often multi-year plans, creating continual pressure to always be on the lookout for solutions one to two years out. When shopping for a platform, ensure it covers all revenue cycle aspects. This reduces the need to constantly create new RFIs and RFPs, which ultimately accelerates your roadmap and delivers faster value to your business partners. Additionally, this helps lessen investment churn and avoid cycling uncertain applications and partners in and out of your ecosystem.


Seek digital-first patient payment + engagement capabilities

A report on patient behavior found one in four people defer treatment because of concerns over the cost of care. Considering that 20-30% of a provider’s revenue relies on patient responsibility, delivering the right experience to the patient has become critical for providers.

In today’s digitally focused world, you’ll want to look for a platform that supports patient payments with omnichannel, personalized experiences. Payment platforms connect broken journeys, from the creation and communication of price estimates to pre-service collections. Indeed, selecting a unified solution ensures those broken journeys are transformed into a seamless process.


Seek solutions for complex revenue cycle problems

Don’t shy away from solving the harder, more complex revenue cycle challenges when looking to consolidate. Some of the most visible problems are also the hardest to solve, and are often the ones that require the highest staffing requirements due to manual touches. Look to solutions that can streamline or even fully automate complex manual processes like authorization, price estimation and claim monitoring. It’s also important to confirm your strategic partner can showcase results and differentiation.

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AI + automation

Today’s health systems and hospitals are challenged by a lack of easy access to detailed payer information and burdened by manual process (e.g., using payer web portals to identify eligibility, check authorization status or claim management). In some cases, like stopping revenue leakage in your coding process, it’s impossible to accomplish without effective technology. Your strategic partner should bring the sort of advanced technology that differentiates their approach from classic EDI and coding solutions from decades past.


Look for integrations + workflows that cater to your needs

There are several keys to maximizing your EHR investment, but one of the most important is allowing users to operate within native workflows as much as possible. The best outcomes in the revenue cycle occur when actionable intelligence (alerts, dispositions, workqueue activity) allows users to focus primarily on touch accounts that need their attention. Perhaps more important is the ability to do so without having to leave the original application. Bolt-ons mean you’ll often have to deal with double touches and swivel chair workflow. Instead, look for platform partners that can effectively speak to integration and complementary workflows versus standalone applications.


Security + reducing risk

Too many point solutions simply create too much risk. HiTrust Certification and SOC II compliance are important to critical patient, revenue cycle and business applications. Choosing a primary revenue cycle platform partner offloads IT overhead related to security audits and application management overhead. It also helps build trust in your organization, allowing for better utilization of your IT staff.


Look for a better partner brand experience—one that patients like

One of the best indicators of a brand’s quality is how likely your peers are to recommend them. Net Promoter Score is a great barometer for measuring how a brand delivers on its promises of technology, implementation and service. Great brands often break a score of 30, and top ones can go well beyond that. But don’t stop there. Check to see how patients score their experience with the platform.

CFO Guide To Smarter RCM Solutions

Parting thoughts: building a foundation for success

The pressure CFOs are under to solve an ever-evolving web of complex financial challenges and adopt more cost-effective measures is a never-ending struggle. That’s why it’s so critically important to select the right solutions and partners when planning for the future. When you make the choice that’s right for your organization, you’ll find you have all the tools you need to build a strong foundation for your future success.

Waystar is here to help guide you along your consolidation journey. Want to learn how we can help you navigate the challenges you’re facing? Click here to learn more.