The COVID-19 pandemic created a host of challenges for revenue cycle management leaders, from widespread service line shutdowns to shifting staff to work at home and increasing self-pay balances. These pressures have heightened inefficiencies in A/R processes and productivity.
While these challenges took a massive financial toll on healthcare organizations—to the tune of $323 billion according to estimates from the American Hospital Association—the pandemic also fostered opportunities for improvement in productivity tracking.
Many healthcare organizations transitioned their revenue cycle management teams to a remote work environment to stymy the spread of the virus. Now, 75 percent of organizations plan to perpetually change their revenue cycle management processes, and about a third of financial leaders expect to do that through more permanent work-from-home (WFH) roles.
More so than ever, understanding and improving productivity will be the key to revenue cycle management success in this new hybrid work environment. “In order to improve speed to revenue and drive process improvements, providers need insight into behaviors and patterns of their payers, patients, and staff,” says Steve Scibetta, vice president of healthcare client success at Ontario Systems.
Hospitals and health systems should not only be measuring their A/R success in total number of accounts worked and total revenue received, but at a more granular level of staff productivity and patient and payer payment behavior. In addition to digging deeper into staff metrics, understanding how to segment accounts effectively, improving adherence to internal procedures, and understanding the best time to call patients and payers can supercharge the potential of A/R portfolios.
“The more insights we have, the more we can design and refine workflow changes to maximize collections and improve not only productivity, but employee and patient satisfaction as well. Both employee and patient satisfaction ultimately impact the success of your A/R organization and increase speed to revenue,” Scibetta states.
Driving Revenue Cycle Productivity In An Office Or WFH Environment
Due to the large adoption of WFH, revenue cycle management leaders can no longer rely on traditional strategies for tracking productivity such as self-reporting of activities, relying on high-level metrics, and siloed revenue cycle functions (i.e., front-end and back-end activities).
Leveraging technology to effectively monitor and measure activities taking place inside and outside of the office can help gauge productivity and ways to improve it. This includes not only staff activities but even activities of payer and patient populations as well.
For example, with televisit adoption and cash flow disruption brought on by the COVID-19 pandemic, the opportunity to collect on patient responsibility is limited to pre-visit payment and back-end revenue cycle management efforts. Tools that provide insight to patient payment preferences early in the process will empower revenue cycle management leaders to easily identify the most successful approaches to collecting and making these processes scalable and repeatable.
Traditionally, total number of accounts worked would be used to measure efficiency. While that is a good start, there are deeper insights that further highlight areas to improve. These include the volume and types of calls (payer or patient, inbound or outbound), active hours per day, number of claims worked per call, and specific activities performed on each account. These metrics identify strengths and improvement opportunities in both operational workflows and individual staff activities. Once strengths and improvement areas are identified, leaders can then set appropriate, attainable goals based on performance to ensure staff members are working at the top of their potential.
Concentrating staff efforts on tasks where they are highly skilled and providing coaching in areas where they might be weak will strengthen individual performance while simultaneously creating a more productive team. Looking at the collective organizational performance can help set team goals as well as raise the bar for lower-performing staff over time.
Additionally, preventing claim denials and unnecessary reimbursement delays become a must in order to maximize productivity and collection potential. This is achieved by understanding payer patterns to further streamline front-end as well as back-end revenue cycle processes.
“With the shift in deductibles putting more pressure on patients to pay, ensuring that payers pay for their piece of the responsibility in full, and in a timely fashion, is essential,” Scibetta advises. “Analyzing claims with the goal of reducing avoidable denials will highlight the refinement of front-end and coding processes to unlock improvements. In addition, identifying which staff are best equipped to work those denials will further influence and drive the speed to resolution.”
Armed with this holistic view, revenue cycle management leaders can optimize workflows down to the time of day when staff members should be contacting a certain payer on the phone to successfully follow up on a claim. This insight also indicates when to avoid calling a specific payer to reduce the time wasted sitting on payer hold.
Leveraging Technology To Ensure Revenue Cycle Success
Data driven technology will be key to informing, tracking, and improving productivity for optimal performance, especially if organizations decide to make remote work a permanent fixture.
Patient engagement is also key to A/R recovery. Revenue cycle management teams should provide staff with the best tools to communicate with patients and improve the likelihood of payments. Convenience and ease both for the patient and the account representative, improve the speed and volume of patient collections and can reduce workload burden of old school, snail mail collections efforts.
“With a growing volume of medical debt and medical offices being forced to close their doors, it’s important to have a good strategy in place along with the best available tools to aid in collecting on patient responsibility,” Scibetta says. “By changing the goal from simply collecting to ‘engaging’ patients, we not only impact the ease of collecting the patient responsibility, but also gain the opportunity to affect their satisfaction and loyalty.”
Patient experience is becoming increasingly important to the bottom line. Research has demonstrated that patients pay less or not at all when revenue cycle processes are not up to snuff. Many patients are even willing to switch providers in order to receive a seamless and convenient financial experience.
The Bottom Line
Hospitals and health systems are likely to face narrow margins in the foreseeable future. The right technology solutions can be key to tracking, informing, and improving productivity and efficiency for optimal financial performance.
With a “new normal” in the way we work, it is more important than ever, that revenue cycle leaders keep their eye on efficiency and productivity in the revenue cycle. Gaining access to and using the right productivity data can drive improvements that will reduce cost to collect and increase revenue recovery.
“Quality of care is the focus of every hospital and health system, but the business of healthcare must be financially strong to ensure sound operation and fuel investment in the latest and greatest technology and talent,” Scibetta states. “A sound and innovative strategy on A/R management and collections is foundational to the larger strategy of quality of care.”