For the Record: Rev Cycling to a Better Bottom Line
“Measuring every touch in the revenue cycle is key to future sustainability—because every touch means money out of your pocket.” ~ Matt Seefeld
Every conversation I’m having now with clients and prospects focuses around labor staff issues – shortages, high turnover, demanding more salary, better hourly rates. Also, everybody wants to work from home. There is so much complexity regarding the cost side of managing a revenue cycle. So, how do you identify in real time where humans are having to get involved in the process? Because when humans get involved in the process, costs go up and your net revenue starts to decline which in turn impacts margin. I think everyone can attest that with no margin there is no mission and cash flow is a good thing. Why is this a challenge?
We can start answering questions in real time, like, What is your work effort rate? How many claims/charges get paid without a human touching it? We can’t know if we are just relying on practice management data. They are not capturing everything you need to measure every unit of work. When I look at views like this, it starts to provide real transparency in real time as to where I need to focus my effort to reduce my dependence on labor. If you look at the zero touch rate in this client above, for example, 50.6% of the charges that go out get paid without a human touch, but half of the charge require a human touch. You can see what percentage of work effort (4.6) is going to clearing the edits. Look at the refile visits rate (7.1%) and the denials (38.9%) in the screenshot above by certain physicians. What’s going on in financial clearance and in coding? What are we not doing right that a human is now having to correct and hopefully get paid what we are suppose to be paid in a reasonable amount of time. Look at the work effort into getting claims paid.
These are measurements that you need to have especially in this day and age where everyone wants higher pay and to work from home. So you have to reduce your labor dependence. We have to go back to the basics of profit margin. Automation is critical, but automation is not going to solve the human problem in its entirety. You will always have humans involved in a process within the healthcare revenue cycle. The key is to minimize that, but you can’t if you aren’t aware of where the breakdown is occurring.
A clean claim is one that leaves the office “clean” (without errors) and is paid timely. But how much work did the claim require before it left the office? A zero touch claim means no one needed to touch the claim before it left the office “clean” (without errors) and is paid timely. You cannot determine how much work effort was required on a claim – even a clean claim – without a workflow automation solution that measures every touch.
Zero Touch | Clean Claims | |
|---|---|---|
Work Effort | Workflow automation tells you how many claim “touches” from the back office were necessary to get paid | Can’t be tracked. Clean claims may still require “touches” from the back office before being sent to the clearinghouse. |
Responsibility | Front office patient financial clearance is responsible for over 50% of denials. Zero Touch Resolution Rate indicates that back office medical billing department spent no time processing the claim | Back office medical billing department may still be spending time and effort making sure these claims go out clean the first time and get paid |
Practice management systems have not and will not deploy the workflow automation and task management system solutions that capture all of the structured data necessary to measure each unit of work done by a revenue cycle FTE that you are paying money for. Twenty years ago when I started my career in revenue cycle management, I would have thought, yes, they would figure it out. Guess what? Here we are in 2022, and they still haven’t figured it out. That means you need to find workflow automation and task management that can sit on top of any PM system. Instead of using a limited data set from a practice management system and finding the right data that your staff can use to warrant the work they are doing, now you can actually measure the outcome or what we at Medevolve call “effectiveness.”
“Measuring every touch in the revenue cycle is key to future sustainability—because every touch means money out of your pocket.” ~ Matt Seefeld
Healthcare organizations are already facing razor thin margins, and administrative waste could be the linchpin for future sustainability. Billions of dollars are at stake. I’m always surprised when I talk to doctors and ask them if know how many touches, or people, it takes to get paid for services they provide, they rarely know the answer. It’s also concerning when administrators and executives over the revenue cycle functions don’t have this information.
Healthcare revenue cycles are primed for the benefits of automation & AI, but many are missing a critical link: human-generated data.
AI can help reduce waste & improve efficiency in the revenue cycle by analyzing human touches & making recommendations for waste reduction.
MedEvolve Rated Top Revenue Cycle Management Workflow Optimization and Automation Solution, 2024 Black Book RCM Client Survey
Healthcare organizations should focus on zero-touch rate—the percentage of insurance claims that require no human intervention for payment.
Five new RCM companies select MedEvolve’s data-driven workflow automation and intelligent analytics solutions.
Reduce RCM labor dependence with financial clearance, coding, insurance A/R, & patient A/R automation modules with real-time analytics.
Increase productivity and simplify front & back office processes while keeping your staff focused with our flagship PM system.
“Measuring every touch in the revenue cycle is key to future sustainability—because every touch means money out of your pocket.” ~ Matt Seefeld
Healthcare organizations are already facing razor thin margins, and administrative waste could be the linchpin for future sustainability. Billions of dollars are at stake. I’m always surprised when I talk
Healthcare revenue cycles are primed for the benefits of automation & AI, but many are missing a critical link: human-generated data.
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