Reduce human intervention in the revenue cycle

Effective intelligence ensures your staff are working effectively and generating the expected revenue

How labor costs affect margin

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?

Knowing Work Effort Rate in Your Revenue Cycle Helps to Evaluate Problems in the Process

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.

Zero Touch Resolution vs. Clean Claims Rate

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

What Practice Management Systems Can't Do

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.”

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The Power of Effective Intelligence to Overcome Revenue Cycle Management Challenges
The Power of Effective Intelligence to Overcome Revenue Cycle Management Challenges

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Reduce RCM labor dependency with workflow automation, task management, & real-time analytics to increase margin.

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Increase productivity and visibility into front & back office processes while keeping your staff focused.​

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