Managing Revenue Cycle Solutions (RCS) in Today’s Challenging Environment
Written by: Cheryl Reifsnyder, PhD
Revenue cycle management is the process healthcare practices use to track patient care episodes, from registration and appointment scheduling to final payments on patients’ accounts. A Revenue Cycle Solution (RCS) is a system for streamlining this process. It offers your practice a host of benefits, ranging from simplified processes and a reduced administrative burden to maximized collections and revenue. An effective RCS can help healthcare providers significantly improve the billing process’s speed, efficiency, and accuracy, significantly improving practices’ revenue collections.
Unfortunately, RCS offerings don’t always deliver on their promised benefits. Please take a moment to learn about some of the common pain points RCS users experience—and what it takes from your RCS partner to ensure success in today’s healthcare environment.
Common pain points for RCS users
Pain point I: It’s difficult to stay on top of the revenue cycle when healthcare is changing so quickly.
Today’s healthcare landscape is changing at an unprecedented pace.
Healthcare segments are experiencing major workforce changes. Practices face a diminishing supply of qualified workers, caused both by increased workforce turnover and increased retirements due to an aging workforce:
- 18% of healthcare workers quit their jobs during the COVID-19 pandemic, and 12% were laid off, according to Morning Consult’s poll of 1000 healthcare workers.
- A Washington Post-Kaiser Family Foundation survey found that nearly 30% of all U.S. healthcare workers are considering leaving their profession early.
Meanwhile, demand continues to rise. The U.S. Bureau of Labor Statistics reported that the number of necessary healthcare positions is projected to increase nearly 12% between 2018 and 2028—nearly double the projected rate for all other occupations.
These factors mean staff recruitment and retention challenges are commonplace in medical practices. In a recent survey of healthcare executives, 65% of respondents rated finding skilled talent as one of their top obstacles to progress.
At the same time, practices face record high expenses as they deal with inflation and a tight labor market. According to Kaufman Hall’s Physician Flash Reports, medical practices’ operating costs have reached their highest level in the past 6 quarters. Staff training costs present yet another challenge. In the healthcare executives’ survey, 47% cited training costs as a leading disruption to their business’s progress.
The cost to retain, attract, and train a skilled workforce is an overwhelming pain point for healthcare organizations—making it an onerous and time-consuming process to maintain a healthy revenue cycle.
Pain point II: Your electronic health record (EHR) platform doesn’t offer a solution specific to managing and optimizing your revenue cycle.
Revenue cycle management is becoming more complicated, now including health information management services, coding, case management, clinical documentation improvement, and patient access, in addition to business office tasks. Changes in the billing and revenue cycle, such as transitions to value-based care and complex billing regulations due to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and Meaningful Use, mean an effective RCS must be continually growing and changing.
To be effective, an RCS requires some degree of flexibility and customization. It needs to adapt to the healthcare system’s changing revenue cycle. It needs to incorporate options customized to your practice’s revenue cycle needs—which too many RCSs fail to do.
Pain point III: Your EHR offers a solution but doesn’t support its platform with people.
The most effective RCS technology is customized to the individual practice workflow and specific EHR build—which means that you need customized training to enable your staff to integrate the solution’s assets into your existing workflows. Too many RCS vendors limit their services to providing the technology, leaving you to figure out how to adapt their platform to your EHR build.
The result? Best case scenario, you might figure out enough of the technology to create a working solution with your practice’s existing EHR and existing workflow—but it will almost certainly take more time and energy (and frustration) as it would with in-person training, support, and coaching.
Worst case scenario, you spend too much time and energy—only to end up with a cobbled-together connection between the RCS and your practice’s established workflows, one that is unable to take full advantage of the assets the technology was supposed to provide.
What do you need in a partner to ensure revenue cycle success in this environment?
When choosing an RCS, it’s critical to find the right partner, not just the right technology, to ensure revenue cycle success in today’s challenging healthcare environment.
Every healthcare practice needs to file claims the same way. The process is standard across the industry. It’s how you go about that standard process that makes all the difference—which is why it’s vital to evaluate potential vendors before choosing an RCS to see whether they have the traits required to help you establish an efficient and effective revenue cycle.
A vendor’s essential traits include:
- Mature, proven platform: The software needs to work—plus the vendor needs to provide you with reasons to trust that it will work (like the reasons listed below); however, this is only part of the equation.
- Experience: A prospective vendor needs sufficient experience with their solution to demonstrate that they know what they’re doing, plus the commitment and organizational structure required to make the most of their expertise.
- Upfront support for your practice management (PM) database: You need a vendor who will develop a PM database tailored to your practice’s specific requirements. Preferably, this should start from a proven template, like our “gold-standard” model; otherwise, you end up with a prebuilt system only somewhat suited to your needs, one where you have lots of features you may never use, while others you need are missing.
- Ongoing human support: Make sure a prospective vendor combines human expertise with their proprietary technology—preferably with a dedicated team.
Do you have reasons to trust that the platform will work?
It’s not enough for a vendor to provide details of what their platform does—they need to provide reasons to trust their claims. Here are some questions to ask prospective vendors when choosing an RCS:
- What are their Performance Metrics?
Require metrics showing their technology’s performance. How do their average clients perform on standard benchmark Key Performance Indicators (KPIs) such as:
- Days in Accounts Receivable (A/R)
- A/R accounts over 90 days
- Denial rates
Note: Our KPI rates all meet or exceed the Medical Group Management Association (MGMA) national averages.
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What volume of payments do they manage? Veradigm manages over $3 billion a year—which, when you consider that these are all from ambulatory practices, adds up to a lot of transactions!1
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How many providers use their solution? Nearly 30,000 users use Veradigm’s RCS services.1
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How long have they been providing their RCS? Veradigm began providing RCS services in 1995.1
Keys to RCS success in today’s healthcare environment
Before choosing an RCS platform, you want to have confidence in the vendor’s offerings. That’s why it’s vital to go through this checklist before selecting an RCS vendor:
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Can they address common RCS pain points?
Can they address your current pain points, offering a solution specific to managing and optimizing your revenue cycle—and supporting their solution with people to help you customize the technology to your practice’s needs? - Do they have the 4 traits essential for success in today’s environment?
- Proven platform
- Experience
- Upfront support for your PM database
- Ongoing human support
- Do they provide reasons to trust their platform will work?
- Performance Metrics
- Respectable volumes of payments managed
- Respectable number of providers using their solution
- Sufficient history of providing their product
Veradigm can provide you with the evidence you need to trust an RCS provider. Talk to a representative today to learn more.
References:
- Data available upon request.