Plan for Revenue Cycle Success in 2020

Setting Your Revenue Cycle Goals

The best hedge against problems down the road is a solid plan. Even the most well-run organizations can benefit from goal setting at least annually. Giving yourself and your staff a set of goals to strive for provides you with benchmarks that help you determine if you are succeeding.

To realize your goals, you need to know how to set them. Goal setting is a process that starts with careful consideration of what you want to achieve, followed by specific steps, and some hard work.

To help set your goals, you can use a proven strategy like the SMART system. Setting SMART goals - Specific, Measurable, Achievable, Realistic and Timely - is the first step in making your goals a reality.

And, once you have chosen your goals, experts suggest three important ways to prevent obstacles from appearing in your path:

1. Create a complete, measurable, action plan that includes all the steps necessary to achieve your goal. Don't forget due dates for each step.
2. Incorporate all your actions into your schedule. Add them to your calendar with anywhere from 10 to 20 percent flextime to help you control any unexpected delays.
3. Regularly evaluate your progress. You may need to make changes or adjustments as your project takes shape. Try to anticipate them so that you won't get blindsided.

Case in Point

Let’s say your first revenue cycle goal is to improve the patient financial experience and increase patient payments. This is an important goal considering how patient financial responsibility continues to expand and become a larger source of revenue for hospitals.

To gain staff buy-in, stress why this goal is important – it should result in happier, more loyal patients and more payments. Outline how you want to improve the patient financial experience, perhaps by providing more payment options that appeal to a variety of patients. 

Next, you want to track your progress by setting benchmarks or milestones for success. For example, Patientco.com suggests that you can track the patient financial experience by following the number of self-service payments (and how they are paying) as well as call volume, patient complaints and the number of bills sent before payment is received.

Understanding why patients are calling is smart because it can reveal trends in the healthcare revenue cycle. It also helps you monitor the factors that influence changes in the patient financial experience.

Help Goals Stay in Focus

That’s just one example of a goal. You will have plenty more depending upon the issues you’re facing in your own organization. You may want to improve denials, make collections more efficient or tweak your percentage of bad debt and charity care. Be careful to keep your eye on these big picture goals when you are working on routine activities and putting out daily fires. A good way to do this is to have a communication plan in place.

One idea: Hold daily “stand-up” meetings where you meet with supervisors and/or staff for just a brief check-in – no one sits down, so there’s less temptation to drag out the meeting.

Make it Easy on Yourself - Automate!

Research from a Black Book survey shows that few healthcare organizations have automated more than 25% of their financial processes, with many of them lagging in modernizing even in customer facing areas like patient access and collections.

In fact, a 2019 Eliciting Insights study (www.elicitinginsights.com) reveals more than half of patient access functions remain mostly manual. More than 30% of health systems rely on manual processes for prior authorizations, patient- and staff- generated pricing estimation, charity screening, pre-visit forms and education materials, presumptive eligibility for charity care, registration quality checks, appointment reminders, and identity verification.

“As an industry, healthcare has been slower than others when it comes to technology adoption, says Lori Zindl, President of efficientC & OS inc., I don’t think it’s a coincidence that we have also lagged when it comes to keeping up with customer expectations.”

Because of the many rule-based activities involved in revenue cycle management, Zindl views it as a great starting point for healthcare organizations to invest more in technology and process improvements.

When it comes to automating your processes and procedures, you can do as much or as little as you like, or your budget allows.  

Start with some traditionally paper processes including bulk claims processes. Other tools include automated payment processing, which can increase the number of patient payments.

Consider automating the following:

• Insurance verification and medical necessity;
• Monitor the entire patient encounter to prevent errors in patient demographics;
• Automate prior balances and patient out-of-pocket costs;
• Search for unreported coverage and any other funding options including government and charity; and
• Audit health plans to maintain compliance with payer contracts.

Let’s be honest, trying to keep up with the latest changes and improvements to technology can be overwhelming. This is where outsourcing can also be a benefit to revenue cycle directors and their employees; let a business partner stay on top of the new technology for you!

It’s a big money and time saving benefit.

Choosing the Right Partners

Any vendor that is serving as an extension of your organization must be up to your standards. Some vendors have staff that are certified in their respective fields, such as coding. Ask about internal training programs that will give the vendor’s staff insight into how a medical facility operates its revenue cycle. If you are going to outsource any piece of your revenue cycle, make sure that the vendor understands your management, vision and values.

Find a business partner that can work with you to provide the services, strategy, tools and data to meet your goals. With so many revenue cycle management service companies around, it isn’t easy to select the right partner.

Ask any potential vendor to show proof of the success they have achieved for other similar organizations. Also, check with colleagues for the vendors they have had positive experiences with. 

Dedicate Time for Review

Healthcare organizations should be looking at all areas of the revenue cycle when they consider automation. Zindl implores revenue cycle leaders to utilize all the tools at their disposal when looking for ways to achieve their goals.

The best software tools, across all industries, come with standard reporting or business intelligence to support process improvement and promote greater accountability.

Revenue Cycle Matters Tip: It’s important to dedicate time (at least weekly) to review reports and dashboards. They are great tools to reinforce quality monitoring and help identify future areas for improvement. If you aren't sure how to use them or it feels like it takes too much time to get the information you want, reach out to the vendor providing the service. They are usually happy to set up time to provide a walk through and share best practices. 

Why Revenue Cycle Matters in 2020?

Setting revenue cycle goals will help your team become successful in the coming year.

Whether it's increasing patient satisfaction, automating billing activities, leveraging business partners, or being more intentional with your weekly schedule, your goals will be your guide.

We hope this information is valuable to you as you look for new ways to conquer your goals this year. If you are interested in learning more about how we can help, consider getting in touch with one of our claim experts for a demonstration of efficientC. 

They will be happy to show you how our claim scrubber and analytics have helped other hospitals increase the effectiveness of their revenue cycle and stop denials in their tracks.