The revenue cycle has changed over the years. From being a simple back office function it has metamorphosed into a complex set of processes and various moving parts, over the years. As the revenue cycle evolves so have the expectations and perspectives around it.
What does revenue cycle success mean in today’s context? The answers differ across job roles and responsibilities. We look at it through the lens of the key stakeholders and what successful outcomes mean to each one of them. And how does the current cost structure and quality programs impact them?
“ It used to be that best-in-class revenue cycle organizations were solely focused on maximizing collections, which certainly is near and dear to me wearing my hat as the chief financial officer. However, today, best-in-class organizations look to leverage each and every patient engagement opportunity as a way to drive total lifetime value of a customer. ” - Lankford Wade, Chief Financial Officer, Summit Health.
High deductible health plans and cost-sharing agreements have transformed the patient financial experience landscape. Patients expect a care experience that is centered around them. Paper forms, fractured processes and an impersonal care journey could mean losing patients to another provider organization. Streamlining patient access functions such as appointment scheduling is crucial to improve the patient experience. As patients become accustomed to shopping around for meaningful care experiences, looking at the revenue cycle from the patient’s perspective is a top concern of healthcare CFOs.
A dramatic increase in patient payment responsibility has steered healthcare organizations towards revenue cycle processes that are closely aligned to the patient journey.
One in seven claims are denied. This is the industry average. Most healthcare organizations struggle with an even higher denial percentage. Where do the cracks lie? The value based reimbursement model places emphasis on the quality of care provided, this has resulted in physicians and clinicians documenting care provided.
As medical documentation and first-level coding shifts from the medical coding department to clinicians, physician education is critical to reimbursement and recouping lost revenue.
“ We know history and exam are no longer relevant for code selection, but you still have to do each for every encounter. We’re assuming that the note is still going to have everything in it that it needs from a clinical perspective. Some doctors have completely abandoned it and just have an assessment plan. That’s not really OK because you still need to have enough to support the clinical element of things ” - Bill Dacey, CPC 1, MHA, CPC.
Healthcare leaders feel physician education is key to prevent downstream issues and contain denials. There is a growing sense of urgency related to the processes clinicians follow to document encounters and implementing systems in place to ensure consistency.
The post-pandemic environment is fraught with uncertainty and operational challenges. The downward macroeconomic pressure faced by healthcare organizations has led to several operational and financial challenges. The major problem faced by provider organizations after the Great Resignation is managing the operational strain caused by staff shortages. A recent survey conducted by a leading revenue cycle firm revealed that about a third of CFOs and Revenue Cycle Presidents felt they had operational deficiencies.
An increasing number of healthcare leaders are looking for a strategic revenue cycle partner to stabilize their cash flow. To ensure long-term success a majority of healthcare organizations are investing in strategic partnerships with revenue cycle partners to manage labor shortages and volume fluctuations.
SolvEdge has two decades of experience in the healthcare industry. We go the extra mile to ensure our clients turn their biggest challenges into their biggest wins. Whether it is enabling better patient outcomes or revamping the revenue cycle we are your growth partner from day zero.
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