Tech optimization: Boosting revenue cycle management

Healthcare IT News lines up five RCM experts in this special report to discuss best practices for optimizing this key financial technology.
By Bill Siwicki
02:08 PM
Tech optimization: Boosting revenue cycle management

Effective use of revenue cycle management technology demands that CIOs, CFOs and other healthcare leaders communicate well and work together to ensure peak conditions for their rev cycle systems. Poor RCM performance can mean lost revenue, which is the last thing any healthcare organization wants.

In this special report, five revenue cycle technology experts – from Experian Health, Myndshft Technologies, VisiQuate, Vispa and ZOLL Data Systems – offer their perspective on strategies and best practices for getting the most out of RCM systems.

The importance of interoperability

Today’s revenue cycle professionals are faced with a growing entanglement of government regulation and payer policies. Thankfully, innovation is providing solutions to eliminate manual processes and reduce the labor costs required to submit a clean claim and receive timely reimbursement, said Juli Forde, channel director for healthcare billing solutions at ZOLL Data Systems, a vendor of revenue optimization technology for hospitals.

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“The power of these tools often is difficult for provider organizations to harness in, with the increasing interplay of billing software, clearinghouse integrations, EHRs and add-on tools,” she said. “A CIO must keep a keen eye on the interoperability of his or her technology solutions to realize their maximum efficiencies and benefits.”

"A CIO must keep a keen eye on the interoperability of his or her technology solutions to realize their maximum efficiencies and benefits."

Juli Forde, ZOLL Data Systems

For most provider organizations, a mix of cloud APIs and interfaces poses the main challenge to achieving true interoperability within their revenue cycle systems, she contended. The lack of true interoperability adds significantly to the administrative burden of healthcare delivery; it is paramount that CIOs consider the overall impact of each individual software application and the feasibility of true integration, she advised.

“An innovative product may include the unique solution to a problem,” she added. “However, without true interoperability, that product may fall short of ROI projections and cause costly delays in both productivity and reimbursement.”

Tech that meets the most needs

On another front, Forde suggested, every revenue cycle organization should select a core solution that can be used to its maximum capability. Finding a core solution that meets the highest number of needs with optimal efficiencies will streamline workflow and improve reimbursement, she said. Often, this core solution will be the tool through which charges are entered, claims are submitted, payments are posted and client reporting is generated, she added.

“In contrast, many organizations work with numerous EDIS systems, practice management solutions, hospital information systems, EHR interfaces and multiple revenue cycle management-IT vendors, which causes significant interoperability and workflow cogs,” she noted.

“A CIO, along with his or her operational leadership, should choose a core solution to be the organization’s foundational system. The cost of implementing future integrations and interoperability functions should be paramount when choosing the revenue cycle solution for your organization.”

Failure to select the right foundation will cause downstream consequences for years to come, she added. A successful CIO is ever mindful of the impact to their technology foundation when considering adding new applications, she said.

Connecting RCM and clinical workflows

As healthcare organizations evolve and shift, post-COVID-19, there will be an earnest look at maximizing technology to leverage approaches like digital portals and telehealth, and if organizations want to forge ahead into a new tech frontier, it means providers’ clinical and revenue cycle workflows need to be better connected, said Michael Ochs, chief technology officer at Experian Health, a vendor of revenue cycle management, identity management, patient engagement and care management systems.

“In order to be successful at the front end, it all starts with the purchase,” he stated. “A best practice to consider is taking a long-term view of your revenue cycle products and solutions, and optimizing the spend.”

"A best practice to consider is taking a long-term view of your revenue cycle products and solutions, and optimizing the spend."

Michael Ochs, Experian Health

Unfortunately, the revenue cycle workflow can be like a puzzle. Up until recently, most offerings were only one piece of the entire ecosystem. This resulted in mismatched pieces and gaps in the workflow.

“Certainly, there is consideration to using best-in-class products for each particular need and patching them together,” he said. “But now there are vendors that offer a suite of products that work seamlessly together, which may be a better overall benefit as the data can flow seamlessly from workflow to workflow.”

In either case, when considering solutions from multiple vendors or a one-stop shop, look at their integrations, he advised.

“What APIs do they have available?” he asked. “You should look at interface engines and standards that they adhere to, such as HL7, X12 and FHIR. Make sure your upstream and downstream products communicate. Otherwise, not only is it inefficient for users to continually context-switch, which also can lead to errors, it results in a bad consumer experience, with disconnected experiences, such as when patients look to schedule an appointment, get test results or pay for their care using digital tools.”

Ochs offers a few things to consider in the ecosystem that an organization’s revenue cycle management process might be missing or have misaligned:

  • Clear and convenient processes for both providers and patients.
  • Accurate patient identification from registration to billing.
  • Streamlined workflows to reduce time and resources spent on avoidable tasks.
  • Automated processes to support effective collections and spot the root causes of denials.
  • Real-time reporting to help improve performance over time.

“Data, analytics and automation can help organizations create more agile processes to minimize revenue leakage and create a better financial experience for patients,” he said. “This all starts with cohesive solutions that can integrate together.”

Business problem analysis

Brian Robertson, founder and CEO of VisiQuate, a healthcare analytics vendor that includes offerings in revenue cycle management, offers another RCM tech-optimization best practice: Overinvest in the why, and business-problem analysis, versus the how and the what.

“There is a natural tendency to gravitate toward tangible things when thinking about best practices to optimize the revenue cycle,” he said.

“As an analytics and technology enthusiast, I am guilty of this all the time, and get excited about the almost limitless potential to automate massive portions of the revenue cycle through a combination of AI and machine learning, robotic process-automation, intelligent process-automation, fast-data wrangling, self-service BI, and elastic and secure cloud computing, to name more than a few.”

But since none of these are in and of themselves a best practice, Robertson recommends that business problem analysis is always king. People remain the most important asset to optimize something as complex as the healthcare revenue cycle, he advised. Technologies, tools, methods and techniques are all secondary to having a clear picture of why it is important or necessary to optimize the revenue cycle, he said.

“For some, 'optimize' might mean incremental improvements into an already high-performing revenue cycle,” he noted. “For others that may have been slower to adopt certain technologies, depending on where they fall in the early adopter to late majority spectrum of the technology adoption life cycle, they may be looking for a leapfrog moment. For another subset, it might be a very bold declaration such as, ‘We will automate 50% of our entire revenue cycle in five years or less.’“

In any of these scenarios, Robertson believes it’s important to overinvest in business-problem analysis, user profiling, user stories and use cases.

“Why are we optimizing the revenue cycle?” he asked. “In our company, we are fans of Simon Sinek’s Golden Circle. Start with why, breakdown how and understand what. If I were a CIO or CFO, I would collaborate with the head of the revenue cycle to nail the why.”

An example of how Robertson thinks about why optimize the revenue cycle would be a why-based vision statement such as: “At ABC Health, we will optimize our revenue cycle by achieving measurable yield improvement and cost reduction simultaneously according to the following five-year measurement scorecard.

“The scorecard should be specific, realistic and measurable. Improving and optimizing cost and elevating the quality of financial outcomes [are] directly aligned with our corporate vision of delivering high-quality services and satisfaction to our patients,” he explained.

“How and what would outline the technology requirements, people requirements, such as outside expertise, and an overall strategy and roadmap for execution.”

Tracking remote revenue cycle workers

Another best practice is to have tools, modules and applications within RCM technology to track remote revenue cycle workers, said Geneva Schlabach, CEO of Vispa, a healthcare revenue cycle management company.

“Tracking revenue cycle workers, whether on-site or remote, is a necessity among healthcare provider organizations,” she said. “Through this pandemic, provider organizations have seen the importance of being flexible with staff while using technology to track and monitor the efficiency and effectiveness of their remote teams.”

"Tracking revenue cycle workers, whether on-site or remote, is a necessity among healthcare provider organizations."

Geneva Schlabach, Vispa

Not only do tracking applications give insight into the productivity levels of remote revenue cycle staff, but they also give management a data-rich view into effectiveness and highlight training opportunities that may improve efficiencies in individuals and systems, she said. As healthcare organizations continue moving forward into a new normal for revenue cycle teams, the demand for IT tools to support productivity and efficiency will only increase in importance, relevance and value, she added.

Accurately track productivity and cycle time

One challenge seen by Ron Wince, founder and CEO of Myndshft Technologies, a vendor of real-time benefits check and prior authorization technology, is that it’s very hard to manage processes that happen in cubicles or – more recently – done remotely.

Most applications for the customers Myndshft is working with don’t have the ability to accurately track productivity and cycle time. Wince sees these as key metrics to providing outstanding service for patients and caregivers.

"Simpler things like taking more advantage of data or simple scripting can help companies squeeze more juice from the tech stacks they have in place."

Ron Wince, Myndshft Technologies

“In the past few years there have been a lot of ‘bolt-on’ analytics tools that can pull data from even hosted applications and turn them into information-rich dashboards,” he explained. “One of the best examples of this was at a DME company that had done a great job of turning data from legacy applications into visualized information that was being used to track everything from claims/hour to tracking sales activity and productivity.”

The applications had been in place for many years but they were extracting data with newer tools that allowed people to self-manage and leaders in the organization to coach and drive performance, he added.

“In today’s environment, it’s not always affordable to upgrade or update technology,” he noted. “Simpler things like taking more advantage of data or simple scripting can help companies squeeze more juice from the tech stacks they have in place.”

Customize the technology

In general, Wince added on another best practice note, technology in these organizations are a bunch of point solutions that have been introduced into the workflow over time.

“There are not a lot of opportunities to customize the technology and it relies on the people doing the processes to figure out workarounds to get what they need out of the portfolio of solutions,” he said.

“We see a lot of what we refer to as ‘swivel chair,’ where a member of the revenue cycle team is in and out of a variety of applications and payer portals – none of which are consistent in terms of user interface. Even more – payer portals can change in their navigation at any point in time and people have to learn how to navigate the new look and features.”

The best organizations have recognized this as a challenge for running efficient operations, he insisted. They are leaning into some off-the-shelf tools like robotic process automation, macros and scripts, and even building simple no-code desktop or web applications that can help minimize the amount of task switching that takes place, he noted.

“These can improve productivity by 15% to 20% just by allowing for more consistent workflows,” he said. “New employees can come up to speed faster and turnaround time is better.”

Price transparency is key

Another best practice for optimization is putting in place a smooth end-to-end automated process that helps patients understand their financial responsibility and pay for their care easily, said Ochs of Experian Health.

“Price transparency has gained momentum and now, more than ever, we have seen the benefits of digital tools,” he said. “For example, a self-service patient portal can give patients convenient access to their information in a time and place that suits them. They’ll be able to schedule appointments, enroll in payment plans, and apply for charity to cover their care costs. They’ll see real-time, transparent and accurate information about price estimates and their eligibility and coverage.”

When the financial experience is transparent and frictionless, patients are more likely to feel satisfied and less likely to shop around for care – not to mention being better prepared to meet payment deadlines, he added.

“And internally, data-driven automated software can help organizations monitor and manage every step of the revenue cycle,” he said. “This makes life easier for clinicians and management teams by using EHR-integrated dashboards, web-based financial reporting and timely alerts for the relevant teams.”

Reliance on manual data entry processes or context-switching means staff members are constantly battling bottlenecks and dealing with avoidable errors and duplicate records, he noted. Not only does this waste employee time, it opens the door to major safety issues and lost revenue: Patient identification errors can cost up to $2,000 per patient, and are associated with a third of denied claims, costing the average hospital $1.5 million each year, according to a survey from Black Book.

“This efficiency can only be accomplished with the right makeup of products that can work together,” Ochs said. “It’s simply no longer viable to use RCM processes that aren’t integrated across your entire digital ecosystem. Providers that can offer a convenient and personalized consumer experience, automate workflows, and connect the dots between clinical care and revenue management will have the competitive advantage.”

Focus on "speed to value"

Robertson of VisiQuate offers a final RCM optimization best practice: Focus on speed to value – narrow and deep versus journeys and waterfalls.

“In addition to rigorous business problem analysis and framing, in the early phases of development focus on accomplishing early markers of success by staying narrow, going deep and then iterating,” he advised. “The world now runs agile. Think of your smartphone. You buy an app, and, whether the app is simple or complex, there are continuous updates using the wisdom of the crowd and agile methodologies to make the app better over time.”

In Robertson’s view, today’s business enterprise is still too slow at the development of technology.

“It still thinks and operates more conventionally, with overdone project management and waterfall-style implementations versus build and deploy in rapid cycles,” he said. “And not to be overly provocative, but many IT and related departments and shops that claim to be or run Agile/Scrum continue to operate under traditional, overly burdensome PMI and waterfall methods.”

Regardless of methodology, speed and value should be measured in smaller pieces and faster cycles, he suggested. For those transitioning to Agile from conventional methods, it is important to allow a reasonable time to find a groove, but measurement of value should be evaluated constantly, he said.

“Measuring value should also be aligned with the ‘why’ as much as possible,” he said. “For example, in our universe we refer to ROI as ROA or return on analytics. In the examples discussed here, consider ROO or return on optimization, ensuring that it remains grounded on why it is mission critical to optimize revenue cycle technology operations.”

For example, he explained, if robotic process-automation is a theme in the overall plan, a narrow and specific goal might be: “We will use RPA to automate our problem with payer-hidden denials, which is where payers underpay and downgrade payments without substantiation. We will invest X dollars and seek Y return by Z date.”

“In this example, the analysis, build and outcomes analysis must be in weeks, maybe months, but not quarters,” he concluded. “Narrow and deep optimization of one component at a time will create a flywheel of rapid and exciting success catalyzing and igniting success. And yes, in some cases, things won’t work, which is why it is important to allow for a certain amount of failing fast.”

Twitter: @SiwickiHealthIT
Email the writer: bill.siwicki@himss.org
Healthcare IT News is a HIMSS Media publication.

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