Hot Topics in RCM: Automation, Patient Experience and Analytics

February 20, 2021 By: Quadax

The AAHAM Annual Conference brought a wealth of insight from conversations with customers, potential customers and industry experts. 

The American Association of Healthcare Administrative Management (AAHAM) National Conference catered to revenue cycle management professionals by offering relevant, thought-provoking content in several tracks:

        • Revenue cycle management (RCM)
        • Leadership/Professional development
        • Operational management
        • Revenue enhancement

Revenue Cycle Automation

Embracing technology is critical in strengthening revenue cycle management and successfully surviving the complexity of healthcare. For small and rural hospitals, it may become necessary to keep the lights on.

Hospital mergers and acquisitions have significantly increased over the past decade with no sign of slowing down. A survey by the Deloitte Center for Health Solutions and the Healthcare Financial Management Association (HFMA) found that nearly forty percent of hospital executives used increased capital from an acquisition to upgrade or implement clinical technologies.

Being able to keep track of a claim throughout the entire lifecycle is a requirement for effective revenue cycle management. If your RCM process isn’t automated or you’re working with an antiquated product, it’s time to consider a new partner. When looking for a solution, here are questions to ask:

        • Will your staff’s tedious, manual tasks be automated?
        • Which processes in the revenue cycle will require human interaction?
        • How are the fees structured (for the software and the services)?
        • Are there automated workflows built in to the system to route documents throughout your internal group?
        • What does their service model look like? How ‘hands-on’ will they be throughout implementation and beyond? Is there a cost for the service?
        • What does the analytics package look like and can you make decisions based on the information you are given from the reports/dashboards?

While the clearinghouse market has reached a mature stage, with most vendors offering a fairly standard set of services, it is nonetheless true that all clearinghouse services are not the same. According to a statement from KLAS Research, “Some of the most significant differentiators as indicated by participants were found within the service delivered by the various vendors in the market. Some vendors do much better at providing high-quality service and support, which is almost transformative in moving the expertise from a vendor/customer relationship to more of a friendship.”

At Quadax, our secret sauce is the perfect blend of great technology with reliable, expert, personal support.

Improving the Patient Experience

Consumers have been purchasing products and services online for years. Book a trip, check your credit card balance, and buy your vitamins with literally one click – all from your phone. Why should consumers expect less from their healthcare providers?

In a study published by Deloitte Review, the authors stated, “Healthcare organizations will need to re-orient themselves around greater transparency – of costs, quality, processes, and services. A key task will be to more effectively communicate the value of products and services in a manner that supports consumers to compare cost and quality information to enable them to make confident decisions about health care.”

The majority of our customers use our product, Xpeditor, for the back-end revenue cycle processes (i.e., claims management, reimbursement management and denials, appeals and audit management). But now, we’re seeing their focus shift to the front-end of the revenue cycle for several driving factors:

        • High-deductible health plan enrollment continues to increase, presenting challenges for providers.
        • Non-reimbursable charges (i.e., deductibles, coinsurance) make up a larger portion of bad debt than ever before.
        • Prior authorization requirements are expanding across specialty areas, which can be a very manual and costly process.
        • Reimbursement continues to drop because of debt reaching higher levels.

On top of the above market drivers, registration errors, authorization requirements, and medical necessity continue to account for a large percentage of claims denials, leading many revenue cycle teams to explore patient access technology and collection best practices to get a handle on plummeting accounts receivables.

If your team is looking to empower your patients with the information they need to better understand their insurance benefits and payment responsibility while also reducing claims denials and decreasing billing and collection costs, it’s time to explore a patient access management solution.

A valuable patient access management solution should be able to demonstrate the following capabilities:

        • Insurance eligibility and enrollment: Verify insurance coverage and benefits to determine patient responsibility and reduce claim denials.
        • Out-of-pocket estimation: Provide patients with an accurate out-of-pocket cost estimate for medical services in advance to improve transparency.
        • Healthcare authorizations: Verify prior authorizations and medical necessity upfront to ensure procedures are approved prior to service.
        • Patient financial clearance: Get a complete picture of a patient’s ability and willingness to pay for services in order to improve cash collection efforts.
        • EDI clearinghouse expertise: Deep knowledge of payer edits and requirements.
        • Simple integrations: Easily integrate with EMR, billing, and scheduling systems to accelerate the claims process with less human intervention.
        • Professional services: Partner with a vendor that will be in lockstep with you – from implementation and beyond.

The bottom line is patients are much more likely to pay their medical bills if they know what to expect before they receive the bill. 

Reporting and Analytics

The third hot topic was all about reporting. No one argues the importance of having insight into data and processes and the benefits realized from having access to that information. Still, only about thirty percent of organizations use data analytics to unlock their potential. This is unfortunate because data analytics has the power to provide $50 billion in annual value to the healthcare system by improving payment, revenue cycle, and pricing. The right analytics solution will give you actionable insight into your data, achieve efficiency across your staff and systems, and improve your financial performance.

The following features should be part of an RCM analytics solution:

        • Data models: Transform complex data into knowledge and recognize relevant relationships between clinical and financial elements for decision making.
        • Real-time analysis: Instantly refresh reports and dashboards at query time to uncover hidden patterns, correlations, and other insights.
        • Benchmarking: Identify gaps and contributing factors, investigate cause-effect relationships to reveal opportunities, and measure results against industry benchmarks.
        • Reporting and analytics: Monitor and optimize performance, track KPIs, scorecards, and progress toward organizational goals with comprehensive real-time reporting.
        • Holistic dashboards: See trends at a high level with a real-time view of selected metrics and drill down to uncover underlying data for root cause analysis.
        • Alerts: Intervene and take immediate action with alerts to remain in control of your financial and operational objectives when key thresholds are not being met.
        • Offline analysis: Download and save dashboards and reports or export to CSV or PDF to share with teammates.

We are quickly approaching another new year, and for most healthcare consumers, that means their deductible resets on January 1 and confusion around insurance coverage will skyrocket. There is a return-on-investment awaiting organizations who move to automation and optimized workflows in their revenue cycle processes.

According to the 2020 CAQH Index, an annual report of the adoption of electronic business transactions, the lack of automation for these transactions leaves $16.3 billion in potential savings on the table. How much of that is owed to your practice or hospital?

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