Due to the complexity of the modern medical system, quality revenue cycle management (RCM) technologies are essential to the financial success of healthcare organizations.
While these RCM solutions are quickly becoming the norm, many providers are still not fully measuring important aspects of the revenue cycle management process. Instead, they rely on generic quota-based metrics or outdated practices that offer incomplete insights into the organization’s efficiency.
If a provider hopes to optimize the productivity of its revenue cycle management team, it must outline and implement RCM-specific standards. These benchmarks allow healthcare organizations to assess productivity levels for individual processes, including billing, claims denials, price estimation, and more.
When leveraged properly, the below measures will provide healthcare organizations with invaluable RCM data to improve productivity, streamline processes and increase revenue.
1. Claim Edits
Claim edits occur very frequently, which means they should be a routine task that can be completed efficiently. Unfortunately, this process is a potential source of significant waste. It can even cause payments to be delayed if staff members are updating electronic healthcare records manually.
By tracking this RCM metric, healthcare organizations are able to identify shortcomings in the claim editing process. They can take steps to remedy the issues, including re-training staff on current software or implementing new RCM technology that can automate routine processes.
2. Prior Authorization
Submitting prior authorization requests to insurance providers can be tedious. This issue is compounded when staff members need to recheck the status of the request daily until the payer pre-authorizes the requested treatments or services. Even though prior authorization processes can drastically impact productivity, many organizations are not tracking how long their employees spend on an average prior authorization request.
If a healthcare organization hopes to improve the efficiency of its revenue cycle management process, then teams should start by monitoring this benchmark. They should also consider automating the prior authorization process entirely to minimize the number of disruptions that their staff encounters during a single shift.
3. Price Estimation
Price estimation should be one of the fastest stages of RCM. A healthcare organization’s staff should be able to provide a patient with an estimated cost of services within a few minutes. If they cannot, it will diminish the patient care experience while simultaneously impacting the productivity of staff members.
As part of efforts to provide optimal patient experiences, all healthcare organizations should actively track this measure. If the price estimation stage takes more than a few minutes, the provider needs to reevaluate its current processes and suite of technologies.
4. Insurance Eligibility
Assessing a patient’s insurance eligibility is another phase of RCM that directly influences the quality of the care experience. If the process of checking and/or updating the patient’s insurance eligibility information takes an excessive amount of time, it can delay later stages of revenue cycle management. Performing this task manually can be particularly inefficient, increasing the chances of a costly data entry error.
Evaluating insurance eligibility is the first phase of the revenue cycle management process, which means that this is an essential standard to track and monitor. If an organization detects deficiencies, it must proactively address them to improve the patient care experience.
5. Information Requested by Payer
How long does it take to provide the requested information to the payer? The more efficiently a provider can collect and deliver this information, the sooner the payer can process the claim. This area represents a major source of delays within the revenue cycle management process.
If deficiencies are discovered, the solution once again lies in RCM automation and the implementation of advanced management technologies. These programs streamline the data collection process so that staff members can rapidly relay requested information to payers. In turn, this reduces costly delays and can help to prevent errors that could result in claim denials.
6. Status Checks
RCM teams likely waste hours every single week conducting status checks on pending claims. By specifically monitoring time spent on status checks, organizations can identify weaknesses in their current RCM practices. They will then be able to improve upon their tactics by taking advantage of new technologies.
When measured in conjunction with other performance indicators, monitoring status checks can provide valuable insight into the overall productivity of the RCM team.
7. Technical Denials
Back office staff members can almost always resolve technical denials. However, healthcare providers must know how long these employees are spending on each denial. In addition, they should track the success rate of corrective efforts as a whole.
For example, an analysis may reveal that the back office spends an average of 12 minutes on a denial and has a clearance rate of 80%. Once an organization begins tracking this metric, it can set realistic goals based on current productivity levels.
8. Appeal Submissions
Healthcare organizations need to monitor both the average amount of time it takes to file an appeal and the current success rates of those submissions. Deficiencies in either category can dramatically impact the profitability of an organization.
Appeals submission statistics are closely correlated with an organization’s overall financial health. This is because an inefficient appeals process will delay payments and may prevent an organization from receiving compensation for some of its services.
Innovative RCM Solutions to Improve Productivity
The benchmarks outlined above will allow providers to break down each phase of the RCM process into individual tasks. In turn, this will enable them to identify the source of deficiencies in their revenue cycle management practices.
Once these shortcomings have been identified, you can proactively remedy the primary issues. The result? A more efficient RCM process and a better care experience for your patients.
Before you can implement these standards, you will need custom RCM coding solutions specific to your organization’s needs. GeBBS Healthcare Solutions provides expert RCM coding services. Our skilled team can build efficient workflow processes for your company, leveraging a combination of automated and manual solutions.
If you want to partner with a forward-thinking technology company that specializes in healthcare RCM solutions, contact GeBBS today.