Setting the Revenue Cycle for Success

Today’s revenue cycle is being reshaped by staffing shortages, technology innovations, and payment trends. Revenue excellence can only be obtained when providers reimagine their revenue cycle to yield financial sustainability and growth.?

Numerous studies by Becker’s and McKinsey & Company have identified three main issues that cause concern for providers and practice administrators regarding their revenue cycle: skilled staffing shortages, harnessing the value of new technologies, and dealing with payer payment trends. This article will take a close look at these concerns.?

1. Workforce Shortage: The healthcare sector is grappling with a significant workforce shortage, impacting the efficiency of revenue cycle management. Providers and practice administrators worry about having insufficient staff to handle billing, coding, and denial management. This shortage can lead to delayed reimbursements and increased administrative burdens, ultimately affecting the financial health of the practice.
2. New Technology Integration: The rapid evolution of automation and artificial intelligence (AI) technologies presents both opportunities and challenges. These technologies can enhance the patient experience, streamline prior authorization, and improve documentation, charge capture, coding, billing, denial management, and analytics. But their implementation requires significant investment and training. Providers are concerned about the initial costs, potential disruptions during the transition period, and the need for ongoing tech support.
3. Chaos in Payment Trends: Unpredictable payment trends, fluctuating reimbursement rates, and complex payer relations create a chaotic environment for revenue cycle management. Providers and practice administrators must constantly adapt to changing policies and negotiate with payers, which can be time-consuming and financially draining. This instability makes it difficult to forecast revenues accurately and maintain financial stability.

Rethink How to Handle Staffing Shortages??

During the past several years there has been a strain on practices looking to hire a skilled workforce that is engaged and competent. Sometimes, employees may not show up for the first day of work because they received a counteroffer. Parts of the workforce are aging out. It is difficult to hire as candidates seek high pay and remote work options and fail to align with the vision and mission of the practices.???

It is important to rethink how we address the workforce shortage. Securing staff for revenue cycle management requires innovative strategies. Follow this guide:?

1. Upskill Current Employees: Provide technology training and foster analytical thinking expertise. This not only boosts productivity but also enhances employee satisfaction.
2. Build Your Own Workforce: Partner with junior colleges and certificate programs to establish internships, ensuring a steady pipeline of skilled workers.
3. Outsource Your Revenue Cycle: This option offers cost containment and ensures high performance by leveraging specialized expertise, allowing your organization to focus on core activities.

Combining these approaches can help maintain a robust and efficient revenue cycle.?

Embrace New Technology Capabilities??

As new technology develops, there is a risk of not having the skilled workforce to implement and manage these solutions. Revenue cycle management has moved toward automation for redundant tasks such as eligibility checking, bill submission, charge capture, cash posting, and status checking. Bots handle these tasks but require monitoring and resetting, often beyond the internal resources of many practices.?

Today, the excitement around AI generative models has led to confusion. Many so-called "AI" programs are merely algorithm-based, akin to first- and second-generation computing. True AI, particularly large language models (LLM), handles complex use cases by reviewing massive data sets, learning from patterns, and providing data for critical decision-making.?

To leverage these technologies, practices must adopt a culture of innovation, exploring possibilities, capabilities, and the continuous improvement journey of today’s technology. This approach ensures that the organization stays at the forefront of technological advancements while managing associated risks effectively.?

Adapt to Payment Trends and Payer Challenges?

Healthcare professional payment trends are in flux, ranging from fee-for-service and direct-fee schedules to value-based and quality outcome incentive risk payment models. This extensive mix makes it overwhelming for providers and practice administrators to keep up with policies and requirements to ensure payment for services. With more than 1,000 different healthcare payers and inconsistent policy changes, practices can experience high levels of denials and lower net revenue resolution rates.?Today's providers struggle to keep up, let alone update their practice management software to prevent claim rejections and denials. The industry is moving toward partnerships to identify and modify technology and processes to meet the demands of these changes, ensuring more efficient revenue cycle management.?

To manage the many challenges in today’s healthcare landscape and achieve revenue excellence, consider these steps:?

1. Enhance Workforce Engagement: Provide education and a sense of purpose to your team. Online certifications on AI and other subjects that can enhance the operation while fulfilling the individual's personal growth yield a desire to participate in the vision and mission of the organization. Understanding and providing for your individual team members’ needs for success creates a safe place to collaborate and lean in together towards a common goal.
2. Assess and Outsource: Understand your team's limitations and consider full or partial revenue cycle outsourcing to fill gaps. If your practice is in a growth cycle, you must understand that with growth you need to be strategic on how you manage the new volume. Outsourcing provides a means to maintain or exceed current performance, so you can focus on expanding the services and most importantly patient care and experience.
3. Leverage New Technologies: Identify and adopt technologies that can enhance patient engagement, digitize documentation, automate routine tasks, and incorporate LLM use cases to streamline operations.
4. Maintain Constant Communication: Keep a consistent dialogue with payers and partner with vendors to stay aligned with regulations and requirements.

Providers and practice administrators that successfully shift their mindsets away from fundamental rigidity and use critical thinking and qualified partnerships to right their ship can achieve revenue cycle excellence.?

Work with the Industry’s Best??

Nextech provides customers a state-of-the-art EHR with a seamlessly integrated practice management system that helps bridge the gap between clinical and financial outcomes. Nextech RCM optimizes the revenue cycle by ensuring your system and processes are streamlined to avoid revenue leakage. The Nextech RCM team provides end-to-end outsourcing services, including training and education for your front-end staff, review of your fee schedules and revenue integrity, and denial management to ensure high performance.??

Optional services include:?

• Coding
• Credentialing
• Revenue liquidation?
• Consulting?

A dedicated account manager will be made available within your time zone providing transparent services, scheduled communication, and stellar reporting. Clients are ensured of a partner-centered approach. Our mission is to let our clients focus on their patients and growth while we deliver your financial sustainability — learn more about how our solution can make a difference for your practice.?

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Nio Querio, Nextech RCM Advisor, has 30+ years’ experience in Revenue Cycle Management for Manager Hospital Systems, PHOs, ASCs, Large Specialty Provider Groups and Primary Care Organizations. Nio was named as one of the Top 25 Innovators of 2021 by “Modern Healthcare.” She previously served as the SVP of Revenue Cycle at Tufts Medicine and currently serves as the Fractional Chief Strategy Officer at Nashville General Hospital.?