Healthcare News & Insights

How to create alignment between hospital practices and RCM functions

It’s no secret that healthcare providers are consistently dealing with stress from reduced reimbursements and lowering margins. In this guest post, Shawn Yates, director of product management for a company that develops a variety of information systems, reveals how effective collection processes and use of insightful data can alleviate these potential issues.


Hospitals and other providers often describe five specific pain points they experience within their revenue cycle management system. These issues include general errors in billing and collection, system architecture challenges, a lack of training, failure to supervise the entire claims process from start to finish and the multitude of claims available.

However, it’s important to remember that these issues are incredibly common. Solving these issues involves straightforward and necessary realignment of provider practices and RCM functions, as well as effective communication. Here are four opportunities to improve the entire system and strategies to get the job done:

1. Pay attention to agent productivity

There are various ways that providers can measure success and efficiency in the revenue cycle process, but one of the most insightful metrics to track is agent productivity. Maybe an agent is spending too much time on one account and neglecting others? Or perhaps they’re spending too much time away from their desk and not completing assigned tasks on time? Having the ability to look at an agent’s productivity at a microscopic level is critical to overall provider efficiency. Luckily, advanced RCM systems are available that make this process even more straightforward.

Advanced systems offer functionalities, such as time monitor tracking and training modules. These offerings not only evaluate the workforce and keep operations on track, but also help agents improve their overall performance. For example, recording calls allows managers to sit down with their teams and go over how specific situations can be handled more effectively. Using this technology, hours can also be appropriately allocated across accounts to provide optimum operational effectiveness.

2. Foster effective communication

Within the typical hospital there are various silos. Maybe billing and collections report to a different department head than coding and registration. This makes cross-departmental communication incredibly tricky. When problems are identified, they must be communicated across all functional areas of an office, so effective strategies need to be in place to prevent communication failures.

One way to accomplish this challenge is to hold monthly cross-functional meetings. However, when every department gets together any concerns or potential problems need to be communicated in a dollar value. For example, stating that there is an issue with 700 accounts isn’t as impactful as saying “This issue is impacting $4 million in receivables.” That’ll get everyone’s attention.

3. Effective management of denials

What are denials in healthcare? Denials are defined as the refusal of an insurance company or carrier to honor a request by an individual or a provider to pay for healthcare services obtained from a healthcare professional. This part of revenue cycle management can quickly become a source of stress for providers. However, there are specific keys to follow that can create better control of denials across departments.

Consider these three strategies:

  • Share data back to all areas of the revenue cycle once it’s received.
  • Make sure useful data is rolling up denial higher-level categories into subcategories, and
  • Be sure to work on a couple of denial categories each month at a payor level to help gain traction.

Utilizing these strategies and best practices will ensure a smooth denials management process across various departments.

4. Automate simple tasks

In general, agents and providers find themselves bogged down with simple, mundane tasks within the revenue cycle process. Ultimately, this takes away valuable time to focus on strategic initiatives or more complex operations. Automating simple processes within the revenue cycle can save valuable time and improve the entire organization. Recent studies revealed that managers are losing eight hours per week due to manual tasks and processes. While eight hours seems trivial, this valuable time adds up to 416 hours per year, which is significant. If providers adopt technology that automates processes, better alignment is created, and providers will experience more value from their RCM process.

When modern technology is combined with effective communication to complement a business strategy, significant value is delivered. This value shows through in functions such as agent productivity, denials management, automation and cross-functional relations. All of which drives positive change for an entire organization.

Shawn Yates is the director of product management, healthcare at Ontario Systemsa company that develops a variety of information systems.

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