10 Mental Models to Streamline Your RCMS – Made Simple

Today, let’s dive into how we can apply some simple but powerful mental models to improve Revenue Cycle Management Systems (RCMS). Each of these models can be a game-changer, and I’ll give you a straightforward example for each.

1. 80/20 Rule (Pareto Principle): Most results come from a few efforts. In RCMS, focusing on the top reasons for claim denials (like coding errors) can significantly boost revenue.Example: If 80% of your denied claims come from incorrect coding, focusing on coding accuracy can drastically reduce denials.
2. Theory of Constraints: Find and fix the weakest link. If claim processing is slow, pinpoint where the delays happen most and address them.Example: If verification delays are the bottleneck, streamlining this step can speed up your entire process.
3. First Principles Thinking: Break down complex problems into basic elements. Simplify RCMS by looking at the fundamental steps in claim processing and rebuild them more efficiently.Example: If claims are often miscategorized, start by defining each category more clearly.
4. Occam's Razor: Choose the simplest solution. Instead of complex billing models, opt for straightforward ones with fewer steps.Example: Build SOP with clear, easy-to-understand steps that everyone can follow.
5. The Chaordic Model (Hock Principle): Simple rules can lead to smart solutions. Set clear, basic guidelines for claims submissions and let the team find the best ways to implement them.Example: Establish a basic rule like “all claims submitted within 24 hours of service” and let teams figure out how to achieve it.
6. Game Theory and Interest-Based Counting: Align interests of all involved. Understand what patients, providers, and insurers need and find a middle ground.Example: Offer flexible payment plans that work for both patients and the hospital’s cash flow.
7. Via Negativa: Remove what’s not working. Cut out redundant steps in your billing process to make it more efficient.Example: If double-checking patient information isn’t adding value, remove it from your process.
8. Inversion: Look at problems backwards. Instead of asking why claims are rejected, figure out what makes them successful and focus on that.Example: Analyze accepted claims to identify what they have in common, and replicate those factors.
9. Relativity: Get an outsider's perspective. Sometimes an external audit can reveal inefficiencies you didn’t see.Example: Hire a consultant to review your claims process and suggest improvements.
10. Velocity vs. Speed: Focus on direction, not just speed. It’s about processing claims correctly, not just quickly.

• Example: Ensure that claims are not only processed rapidly but also accurately to avoid future denials.

Implementing these mental models in RCMS can lead to simpler, more efficient processes and better results. Give them a try and see the difference they can make!