Optimizing your revenue cycle management process is a key component for addressing a multitude of industry trends such as changes in regulations, consumerism and new reimbursement structures.
Today’s patient centric revenue cycle requires the right systems to drive performance; however, employing systems based solely on their robustness does not guarantee success. Optimal financial performance is only achieved with a careful balance of people, processes and technologies.
Revenue cycle performance in healthcare is particularly challenging due to the complex nature of services to be billed, the large number of employees contributing to the process, the array of systems and tools used to process billing, the evolving interactions with patients and their growing payment liabilities due to an increased responsibility for the costs of care.
Performance Metrics and Sustainability
The revenue cycle can be broken down into two main areas: pre-service or what is considered financial clearance and post-service, typically referred to as financial settlement. These functions include registration, bill estimation, case management, discharge billing, post-service billing reconciliation and collections.
Revenue cycle performance in these domains is only sustainable with unremitting efforts to maintain accuracy and measure performance. Identifying and measuring overall outcomes offers general benchmarking information but is not actionable. Adjusting revenue cycle activities for optimal outcomes are required with the specific actions that should be pursued. The foundation for best practice revenue cycle management begins with selecting metrics based on existing best practices. These best practices should present guidelines for the most efficient or prudent course of action and reflect the preferences and financial priorities of the organization.
Revenue cycle metrics can be broken down into two types: operational and strategic. Operational performance metrics require consistent monitoring and should provide ample information to drive operational improvement and quality, and validate sufficient progress toward workflow goals. Strategic metrics comprise financial, operational, customer service and quality measures that give executives a high level overview and track trends by month or current fiscal year.
High-performing healthcare organizations that operate best practice revenue cycles use the revenue cycle to continually enhance their day-to-day operations and improve patient experiences and financial recoveries. These best practices give organizations looking to make positive changes in revenue cycle management numerous areas in the revenue cycle on which to focus their attention.
25 Keys to Patient-Centric Revenue Cycle Performance
Today’s healthcare environment of increased regulations, growing patient payment liability, and risk-based pay-for-performance models and diminishing reimbursements necessitates revenue cycle strategies that meet industry standards. From pre-schedule to accounts receivable payment and cash posting, revenue cycle processes must be aligned in order to secure proper reimbursement from payers and patients. The following are 25 Keys to a Patient-Centric Revenue Cycle which, when implemented, will drive positive financial results and improve the patient’s overall experience.
- Implement an all-encompassing strategy that measures collection goals, workflow benchmarks, policy adherence and key performance indicator milestone attainment.
- Post and communicate to patients the hospital’s financial assistance, discount and prompt payment policies.
- Remind patients of their payment obligation and attempt to collect the patient portion when performing appointment scheduling confirmation calls.
- Educate patients to be prepared to pay for services upon arrival at the hospital or clinic.
- Utilize integrated scheduling and registration tools to handle patient visits and accurately move patients through the billing process.
- Use a registration quality and scoring technology to accurately classify self-pay patients at point of service to improve collections.
- Employ real-time technologies that notify registration staff of Red Flags Rule irregularities and fraud alerts.
- Help patients understand what they will owe at pre-registration, registration and patient check out with an effective bill estimator.
- Partner with a vendor who offers a cost-effective, unlimited-use real-time insurance eligibility verifying program to check eligibility of patient accounts at any point throughout the revenue cycle collection process.
- Introduce a comprehensive program to help patients apply and qualify for various state and federal financial assistance programs.
- Install a web-based patient intelligence platform to analyze real-time workflow performance.
- Leverage call center technology to manage call volumes, improve customer service, improve time efficiencies and increase first call resolutions.
- Post patient financial services staff in the emergency department to collect co-pays, deductibles and self-pay balances.
- Collect a pre-determined deposit from emergency room patients during quick registration and reconcile total estimated payment due through a bill pay estimator.
- Preauthorize credit cards and checks at the time of scheduling, registration or any other collection checkpoint.
- Apply a self-pay point of service collection strategy for collecting previous and current balances.
- Use a self-pay collection scoring technology that creates workflows through algorithms that estimate the ability and propensity of payment.
- Implement a self-pay charity scoring workflow that estimates charity and financial discount write-offs before bad debt placement.
- Use an integrated scanning technology to maintain accuracy while improving the identification and proper storage of patient records.
- Implement an advanced technology to collect credit card, debit card and Automated Clearing House (ACH) payments.
- Offer a web-based payment portal for patient bill pay.
- Implement e-cashiering to give patients additional options to pay.
- Utilize a predictive dialer that blends inbound and outbound calls, closely monitors right-time calling analytics and sends out-patient friendly statements.
- Provide ongoing face-to-face and web-based collection and customer service training with the goal of ensuring that all self-pay patients are treated with respect, dignity and professionalism.
- Offer continuous training programs to educate staff on their responsibilities.
An important part of any well-balanced and productive revenue cycle is ensuring that there is a clear understanding of how to serve the patient and meet their wants and needs so that their healthcare encounters are less stressful and more clinically productive. Closing the revenue cycle loop with patient satisfaction surveys gives healthcare stakeholders the feedback required to build and operate an efficient and patient-friendly revenue cycle.
To maximize revenue cycle efforts, healthcare organizations need suitable technology, adequate internal work processes, experienced people and appropriate metrics. Without these pillars, organizations will struggle to operate efficiently. Focusing inward on revenue cycle best practices is crucial for maintaining operational excellence without losing sight of the impact of a positive patient experience on revenue cycle performance.
Phil C. Solomon is the publisher of Revenue Cycle News, a healthcare business information blog and serves as the Vice President of Marketing Strategy for MiraMed, a healthcare revenue cycle outsourcing company. As an executive leader, he is responsible for creating and executing sales and marketing strategies which drive new business development and client engagement. Phil has over 25 years’ experience consulting on a broad range of healthcare initiatives for clinical and revenue cycle performance improvement. He has worked with industry’s largest health systems developing executable strategies for revenue enhancement, expense reduction, and clinical transformation. He can be reached at firstname.lastname@example.org