Top 4 Reasons Your Revenue Cycle is Probably Struggling (and What to Do About It…)

Posted in Gebbs Healthcare

Hospitals have historically operated with fairly lean profit margins, but what happens when those margins continue to shrink? Everyone knows healthcare reform is critical to the future of US hospitals but getting there is proving to be more difficult than many experts anticipated. Straddling the line between fee-for-service models of care and the shift to value-based care is more than some organizations can handle – and revenue cycles are paying the price.

Hospitals with struggling margins have a laundry list of big problems. Layoffs and/or reduction in benefits programs or merit-based raises may result in high turnover, problems recruiting and retaining staff, and worst of all – the quality of patient care delivered may suffer. Sound familiar?

While there’s no easy way out – if you’re not sure where to start, here are four critical factors that could be impacting the health of your revenue cycle. Addressing these issues head-on can help identify opportunities for short-term improvements that can bring long-term gains.

1. Trouble Recruiting RCM Staff –
You can’t very well focus on improving your revenue cycle if you don’t have the expert staff to do it. Skilled medical coders and various A/R experts can be difficult to recruit. Tips for retaining and recruiting staff include the use of sign-on bonuses, offering funds for continuing education and training, and ensuring an exceptional RCM leadership team is in place that values and appreciates staff at all levels.

2. Increasing Workload – The complexities of payer contracts combined with the whole new world of value-based reimbursement means there is a lot to learn – all while the workload continues to pile up. Consider bringing in contract support or partnering with an outsourced partner to offload some of the work. If you find the right support, the investment will pay for itself in short order.

3. Lack of Innovation – Most hospitals spend their innovation budgets on solutions designed to improve patient care. While this makes sense, back-office functions such as RCM tend to get left in the dark ages when it comes to technology and innovation. The good news is the technology to help hospitals’ revenue cycles is out there – using artificial intelligence and sophisticated analytics, organizations can pinpoint specific areas of opportunity that can quickly deliver significant RCM improvements.

4. Payer Pressures – Payers are also working hard to transition into the world of value-based care – and are facing similar challenges that come with navigating a whole new world of care delivery. They’re also implementing advanced technologies that can better detect problems such as a lack of adequate documentation, etc. These changes are leading to contracts that are more complex and more denials – which can cause real headaches for overburdened RCM teams.

While value-based care and reimbursement are ramping up, many hospitals are looking for short-term support to help ease the transition. Bringing in an outsourced vendor that has expertise, exceptional staff and innovative technology can help struggling hospitals improve their margins quickly. GeBBS Healthcare Solutions offers a wide range of revenue cycle management solutions. For more information, visit gebbs.com or call us today at (888) 539-4282 to speak with our Solution Expert.