With a shift from fee-for-service to value-based reimbursement, it is imperative for healthcare organizations to improve their revenue cycle performance in order to earn higher margins. Value-based care demands reduction in costs, focus on population health and delivery of high quality health services to all the patients. These goals can have a significant impact on revenue cycle, but healthcare organizations can achieve these goals without a reduction in their margins by:
1. Analyzing appropriate data to track performance: Key performance indicators (KPIs) must align and support every aspect of the revenue cycle. The leaders and the finance people must use advanced data analytics and regularly review the data to know where their revenue cycle is trending and what actions should they take to improve it. The organization can use digital dashboards to show the trend of the KPIs and how they compare with the industry benchmarks. This will help the leaders in identifying the troublesome areas that can have an impact on the organization’s bottom-line. 2. Creating a revenue cycle team of key people: The dashboard showing KPIs can only be useful if key people effectively use it to make decisions for the improvement of the revenue cycle. A committee should be created consisting of the shareholders, executives, clinicians, and financial leaders. The committee members must have access to the digital dashboard so that they are aware of the major issues and can decide how to improve certain things like billing, coding, claim denial, etc. 3. Identifying strengths and weaknesses: It’s not necessary that every organization must have the capability and expertise to resolve various issues regarding the revenue cycle. However, organizations must be aware of the areas where they lack even if their margins are good because there is always room for improvement. The leaders must observe the strategies and actions of peer organizations in order to understand the factors which are playing a key role in the improvement of their revenue cycle. In addition, leaders can also take advice and help from revenue cycle consultants. This will allow them to know what is going wrong and how things can be improved. 4. Setting targets and measuring performance against those targets: Data collection, data analysis and tracking of performance measures makes more sense when financial leaders and clinicians know the targets they must achieve in terms of the KPIs. The leaders must set realistic and achievable targets for each KPI at the beginning of a fiscal year as well as monitor their progress regularly. Moreover, they must hold departments or individuals accountable for the results. 5. Using patient-centric technologies and services: Leaders must deploy patient-centric technologies which can help patients understand the billing and collection process and provide services which can allow them to make payments electronically, determine their covered benefits, estimate their out-of-pocket cost and much more. This will boost patient satisfaction and have a positive impact on reimbursements. 6. Optimizing the use of existing technologies: Some organizations don’t take full advantage of the applications available in their current revenue cycle management systems which can help in improving the performance of their revenue cycle. For example, only 44 percent of the hospitals recently surveyed by HIMSS Analytics said they use a vendor-provided claim denial management solution. 7. Focusing on claim denials: According to a study, U.S. hospitals daily write off roughly 3-4 percent of net patient revenues because of claim denials. Nobody can afford to lose revenues in such a tight market. Therefore, organizations must work smartly and focus on quality vs. quantity of work to safeguard revenues and prevent claim denials. Leaders can seek help from revenue cycle management solutions or outsource parts of their revenue cycle. 8. Focusing on patient experience: Organizations must recognize that patient satisfaction is as important as clinical excellence and it plays a vital role in driving reimbursements. Adreima, a firm which provides patient advocacy services so that patients can better understand and manage their bills and insurance, found that these types of services resulted in 29% increase in payment rates due to increased patient satisfaction. 9. Creating a culture of value for the revenue cycle: The staff should be educated about how their performance can impact the entire revenue cycle as well as influence patients’ experience. They must be informed about the KPIs so that each department or team can know their level of performance and improve in the future. Moreover, the leaders must acknowledge and celebrate the achievements of employees so that others are motivated to improve their performance. 10. Hiring the right people: It is important to hire the people who are aligned with the culture of the organization, otherwise their performance and values might influence the bottom-line. Source
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