What are "wasted touches" in the revenue cycle & how do we prevent them?

Administrative waste accounts for 26% of wasted healthcare spend

Waste in Billions of Dollars

https://www.pgpf.org/blog/2023/04/almost-25-percent-of-healthcare-spending-is-considered-wasteful-heres-why
Journal of the American Medical Association, Waste in the US Health Care System: Estimated Costs and Potential for Savings, October 2019

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.

But it’s not the fault of doctors or administrators—their practice management and EHR systems were never designed to measure these metrics. These systems are purely transactional: get the claim out the door and hope it gets paid. The key to collecting the human data and tracking all the touches in revenue cycle to reduce waste is having solutions in place such as financial clearance and insurance workflow automation combined with task management and intelligence analytics.

Wasted touches increase labor costs

Claim Status
Touches
% of Total
Claim in Process
42,282
24%
Claim Paid
21,078
12%
Denied
46,797
27%
Denied – Medical Records
5,350
3%
Denied – Add. Info Requested
5,266
3%
Denied – Coding
9,698
6%
Denied – Pre Cert / Auth
5,606
3%
Denied – Timely Filing
2,473
1%
Denied – Eligibility / COB
7,711
4%
Denied – Missing / Invalid Info
9,319
5%
No Claim On File
5,902
3%
Action Taken
Touches
% of Total
Escalate to Supervisor
4,905
3%
Rebill Claim
16,352
9%
Bill Patient
8,996
5%
Claim in Process
30,787
18%
Posted Transaction
15,054
9%
Sent a Task
16,606
10%
Calculations
Visits Worked
150,724
Claim Touches
174,365
Cost Per Touch
$3.00
Wasted Touches
50%
Annualized $
$1,046,190
Patient Searches
54,006
% of Total
36%
AVG Touch / Visit
1.2

We see this pattern every time we start working with a new provider organization. Usually, within the first week, the same trends emerge. We find that more than 50% of touches are wasted by the AR team. What does that mean? For example, a representative contacts the insurance company, receives information, but no action is needed at that time, such as being told that a claim is still in process or that it’s already paid but hasn’t been posted by your team yet.

For instance, one group had 174,000 touches over a certain period, with a cost of $3 per touch. That’s nearly a million dollars wasted. Of those touches, 63,000 were simply checking the status of a claim (like “claim in process” or “claim paid”), making up 36% of total touches within a three-month period.

Now, let’s look at denials. When you analyze overall touches, where do we find the biggest issues? Authorization, eligibility errors, missing or invalid information, and even cases where no claim is on file. Is that due to a missing secondary or primary claim? These are questions we uncover by analyzing the human data. During implementations, post-implementation, and ongoing client success, we ask, “Why is this happening?” Some issues are straightforward, like missing pre-certifications, while others require deeper analysis to truly understand where the breakdown in the revenue cycle the problem started.

Another trend we notice is escalations. If 3% of claims are being escalated to a supervisor, we need to ask why. Are staff not trained to resolve issues on the first try? Are there missing protocols? Are certain reps escalating more than others? We need structured, real-time data to make informed decisions.

We also found that resolution rates drop significantly when delegation is involved. For example, if I work on a denied Blue Cross claim for medical records, I may need someone to submit those records, which adds touches. Now, it’s not just me handling it—medical records might touch it, and it could be sent back to billing or even back to me. That’s three touches, and the resolution rate drops below 50% when delegation is needed.

This highlights the importance of streamlined communication. If AR reps need help, they can’t rely on spreadsheets or emails anymore. Every task must be linked to a visit to measure the total economic waste involved in collecting on that visit. Every touch needs to be documented and measured—that’s the reality we’re in.

Patient searches are another concern. Even with sophisticated workflow automation, some staff might be bypassing the systems and worklists you have in place to search for accounts manually. If 36% of your claims are coming from patient searches, it indicates a lack of accountability. The goal is to provide management with actionable insights to change staff behaviors.

Coordination between people, process and technology is paramount to streamlined, efficient revenue cycle management. Once you have the ability to track all of the human data in the revenue cycle with workflow automation and task management, then you can identify problem areas and put better processes in place to reduce the touches your staff are taking every day. Managing the human element of the revenue cycle is one of the only areas that providers have control over these days to be able to improve margin and reduce cost, which are critical for future sustainability.

About Matt Seefeld

Matt Seefeld, Executive Vice President & Chief Commercial Officer at MedEvolve, brings over 24 years of management consulting experience in the healthcare industry. He has extensive expertise in the assessment, design and implementation of process improvement programs and technology development across the entire revenue cycle. Matt began his career with Stockamp & Associates, Inc. and worked for both PricewaterhouseCoopers LLP and Deloitte Consulting LLP in their healthcare and life sciences practice lines. In 2007, he developed a business intelligence solution and founded Interpoint Partners, LLC, where he served as Chairman and Chief Executive Officer. In 2011, he sold his business to Streamline Health Solutions where he then served as Chief Strategist of Revenue Cycle followed by Senior Vice President of Solutions Strategy until 2014. Matt ran global sales for NantHealth and provided consulting services for healthcare technology and service businesses nationwide, prior to joining MedEvolve full-time.

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