HealthWare Systems Blog

Revenue Cycle Software: 3 Steps to Stop Spinning Your RCM Wheels

Posted on Wed, Jun 17, 2015

Revenue cycle software virtually defines the success of today’s hospitals. When cash is coming in on a predictable, steady basis, facilities can manage expenses, retain top-tier medical talent, and roll out life-saving advances in patient care.

But healthcare revenue cycle management is more complex than RCM in other industries. For one thing, the payer mix is widely varied (and getting more complicated all the time). The chain of providers and care coordinators is also much longer than those in service models outside of healthcare.

Taming the complexity without creating redundant tasks and excessive positions fuels an ongoing debate—one that’s culminated in an official task force. Indeed, the RCITF is now calling for industry-wide collaboration to “rethink the current RCM model completely.”  But so far the RCITF’s vision for the “Patient Financial of the Future” has been solely focused on the what. In FY16, they will begin to spell out the how, in terms of workflows and technology systems.

What should your facility be doing in the meantime? These three steps and revenue cycle software options (sometimes described as “bolt on”) are still the cornerstone of any solid RCM strategy:

  1. Define and communicate each RCM employee’s role.

Lots of different employees play a role in revenue cycle management. One health system VP estimates roughly 250 people are involved in creating a single hospital bill. Hospitals need to standardize the process (to whatever degree possible among different departments), then clearly communicate the responsibilities assigned to different parties.

It may seem obvious that administrative staff understand their job duties, but plenty of physicians and nurses still don’t grasp (or follow) set procedures.  In the pre-arrival process, for example, clinical and financial clearance should be streamlined and benchmarked. Health management software for preregistration supports address verification, insurance eligibility, medical necessity, and other RCM-defining activities—which leads us to the second step…

  1. Provide the tools necessary to accomplish those roles.

It’s one thing, for example, to insist that intake staff vet physician orders for full detail and signature. It’s another to insist that rejections, follow-ups, and resolutions occur in a timely manner, when manual operations and paper-based exchanges are required. More than ever, healthcare employees need digital order management software to streamline revenue cycle activities. They need the ability to reject, return, or else re-route acceptable orders to the right department with a single click.

  1. Establish your most defining RCM metrics, and train teams to perform accordingly.

As Lindy Benton, CEO of MEA | NEA recently explained in HIT Consultant, “organizations [should] provide enterprise-wide training, job aid and performance support for those engineering and operating the RCM chains.” Benton goes on to list some of the key performance metrics that dictate ROI on revenue cycle efforts.

Can your hospital leaders can get their hands on real-time RCM data—like, what’s your average patient registration accuracy figure? How effective are your POS collections? There’s already an easy, cost-effective way to monitor metrics like these on a daily basis. And when you have an RCM dashboard  at your fingertips, decisions about training and job aid become a lot simpler.

What are your thoughts on revenue cycle software with “revolutionized” RCM in the offing? What’s your stance when it comes to rethinking RCM? Please share your comments below, or follow and DM us on Twitter.