Tag: R1 RCM

Evaluate, Plan, Validate and Fund: Laying The Groundwork For RCM Transformation

By Joe Polaris, senior vice president of product and technology, R1 RCM.

Joe Polaris

This year promises many new opportunities to apply technology to improve the healthcare revenue cycle. The recent HIMSS conference, for instance, featured many exciting use cases for machine learning and artificial intelligence (AI). However, before rushing to implement any of the latest solutions, let’s step back for a moment.

While there is plenty of emerging revenue cycle technology, there is also still a fair amount of complexity when it comes to implementing these capabilities. Most organizations typically have a significant amount of disorganization to deal with on the back end of their billing processes, as well as disparate technology systems that don’t work together. Many organizational leaders also are growing tired of only achieving incremental improvements to the revenue cycle through stand-alone revenue cycle management (RCM) technology, especially with rising total administrative costs and cost to collect.

That means we simply cannot afford to implement “quick-fix” RCM technologies that fail to support future goals. In an industry known for emphasizing quarter-by-quarter financials, we must begin taking a longer view. Rather than trying to establish 2019 implementation priorities, think about using the rest of 2019 to set the foundation for a holistic RCM transformation.

Perhaps the question to ask this year is: “Where do we want to be in three years – in terms of process efficiency, cash flow and an experience that delights our patients?”

Map RCM to the patient journey

Answering that question requires a holistic assessment of the entire revenue cycle, especially as it relates to the patient journey. Although that’s not a small undertaking, it allows healthcare organizations to build a thoughtful, realistic roadmap for long-term RCM transformation. In turn, such planning helps organizations realize greater value from all their RCM technology investments. Consider these four steps:

Evaluate: Although some healthcare organizations are further along when it comes to more efficient and patient-centered RCM, most are just starting to explore due to a wide variety of situational limitations. Escaping such constraints will require you to map out the entire patient journey end-to-end. Then, look at the map to identify areas of potential revenue cycle satisfaction for patients, as well as their most significant pain points.

Plan: After evaluating your RCM strengths and weaknesses, prioritize those processes in which technology has the greatest potential to remove waste, create capacity or give back operational expense. When deciding which solutions to implement, remember to take a broader, longer-term focus. Your organization should avoid the temptation of “quick wins” and instead focus on a viable long-term path that will meet your holistic, collective objectives. By generating a long-term plan, you will also incrementally create business value and move toward a more well-defined end-state vision. The most impactful digital transformation might come from phasing in the adoption of a comprehensive platform, as well as combining digital self-service technology and other automation capabilities — some of which may take hold quickly, while others may require more time.

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Elements of a Successful RCM Process

The revenue cycle management (RCM) process is one of the most vital parts of an efficient and functional healthcare entity. The vitality of this process to the healthcare industry as a whole cannot be understated, and it continues to grow with each passing year. In fact, it is predicted that the RCM market will reach more than $43 billion by 2022, underlining the increasing importance RCM has for healthcare providers. By offering the process by which healthcare providers receive reimbursement for their services from insurance providers, proper RCM can be the difference between sinking and swimming for healthcare facilities.

In understanding the facets that go into an effective RCM process, it’s important to note the key factors that successful RCM processes tend to share. These fundamentals all contribute toward creating an RCM process that brings the best results for healthcare facilities while minimizing their pain points and streamlining the experience for patients. Healthcare providers would do well to examine their RCM processes closely and determine whether or not these key fundamentals exist within their systems. If not, they may need to take a stark look at their processes and make significant changes if they are to have any hope of functioning at optimal efficacy.

For example, high accuracy is one of the most vital features of a successful RCM process. Without high accuracy, the data healthcare providers use to optimize their processes may be lacking, leaving them open to making serious errors in judgment. In turn, creating a domino effect that can have catastrophic effects on the rest of their RCM framework. Successful RCM processes also must incorporate a physician advisory module or component that can provide physicians with the resources from which they can navigate the regulatory environment with better success and ease. This can reduce obstacles that are encountered commonly with regards to legal requirements — in effect, streamlining the entire RCM process.

The below infographic from R1 RCM outlines these and the many other aspects that go into creating a successful RCM process for healthcare providers. Understanding these key components only becomes more important all the time. Meaning, there’s no excuse for not getting started on building a better RCM process today.

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