Training, Education and Artificial Intelligence Can Help
The Great Resignation is one of the more recent problems triggered by the COVID-19 pandemic. According to the U.S. Bureau of Labor Statistics, 4.3 million people, or 2.9 percent of the workforce, quit their jobs in August 2021. This exodus has rolled across the U.S. like a wave, with healthcare one of the most adversely affected industries.
Clinical and support personnel are resigning from jobs at hospitals of all sizes, leaving departments shorthanded and driving up salaries. Staff are leaving because of vaccine mandates, burnout or better opportunities, and revenue cycle management is no exception. As a result, costs to collect are rising, and collection rates are dropping. The American Hospital Association (AHA) estimates that U.S. hospitals lost $323 billion in 2020. With gross revenues continuing to decline and expenses rising, nearly half of U.S. hospitals have negative operating margins.
Better revenue cycle management eases the pressure on this downward spiral. However, it requires an in-depth assessment of the way hospitals handle claims processing, payment and revenue.
Revising the Revenue Cycle from Patient Intake to Zero Balance
Hospitals, no matter what their size, usually lack the bandwidth and objective viewpoint to transform business operations. Windham Brannon Healthcare Advisors offers a rapid revenue cycle assessment to help executives quickly identify areas of improvement to identify cash acceleration and net revenue opportunities. We work to improve the following functions:
- Billing and collection errors
- Staff training
- Monitoring collections
- IT deficiencies
Training your staff has significant benefits because it reduces human error and makes the reimbursement process more efficient. We demonstrate proper coding and correct chart documentation, which reduces claim denials or reimbursement delays. In our experience, all hospitals should invest in regular training. New hires need it, but so do veteran staff members in order to handle updates in electronic health record (EHR) management and cybersecurity requirements.
We also connect hospitals to a network of interim leaders. We’ve worked with these experts for more than 25 years, so you can trust them to handle revenue cycle management. They understand the value of best practices and offer “plug and play” expertise while you recruit long-term leadership.
Staff Shortages Mean More Trouble for Rural and Critical Access Hospitals
Rural and critical access hospitals often have three or four people handling the revenue cycle, and they tend to work the way they’ve always worked, unless someone teaches them a better way. These hospitals are already struggling with revenue losses, so staff shortages compound their problems. They need trained, qualified staff to manage from the front end to the back end. Three people in the business office trying to maintain A/R are easily overwhelmed, and collections can be left on the table. Co-pay A/R can add up to multimillion-dollar losses.
These hospitals need to improve staff productivity and reduce waste and error, which require a knowledge base of consistent, standardized policies and processes. With these in place, training replacement personnel becomes more efficient and ensures better continuity of operations. Our training focuses on front-end tasks. Reducing errors during patient registration eliminates the problems that would otherwise extend through the revenue cycle, preventing timely reimbursement.
We offer a special Revenue Cycle Optimization program designed specifically for rural and critical access hospitals. A dedicated advisor will not only work with your leadership and staff to identify and implement improvements across the revenue cycle, but will also tap into the depth of experts within Windham Brannon to support ongoing initiatives. Organizations typically achieve a positive ROI within the first two months of participation in the program.
Addressing the Challenges of Large Hospital Systems
Large hospital systems often address administrative staff shortages with remote workforces. A workforce scattered across different states makes revenue cycle streamlining more difficult. Large groups of coders working remotely may have sporadic oversight of coding and billing compliance. Driven by payer denials, backlogs of insurance balances accumulate, causing lack of follow-up and revenue leakage. Lacking visibility into their financial data, their billing departments don’t know how to develop and implement new policies.
We measure staff productivity and identify systemic inefficiencies. Our process includes A/R studies. These reports guide the way revenue cycle departments can reprioritize their efforts. Front-end staff are critical to the revenue cycle process. Improving their billing and coding compliance yields a rapid return on investment. Large hospitals, rural hospitals and critical access care facilities aren’t the only groups facing these revenue cycle challenges. For example, we recently spent fourteen months working with the billing department of a large physicians’ group. Our assessment, insights and process-based improvements helped them capture $20 million in net revenue.
Windham Brannon also trains revenue cycle staff who work remotely. The firm has an experienced cybersecurity practice, and we work closely together on healthcare engagements. The rise in popularity of “Bring Your Own Device” policies increases the risk that hospital IT systems face from cyberattacks. We work to ensure that staffers’ use of personal laptops, tablets and mobiles comply with best practices and protect patient data.
Using Artificial Intelligence to Optimize Revenue Cycle Management
In addition to revenue cycle training and education, organizations should evaluate artificial intelligence (AI) technology solutions that can help streamline routine operations. Revenue cycle is a transaction-heavy process, with significant levels of repetitive and predictable activity. Smart automation is ideal for claims status, denial management, prior authorizations, referrals and pre-certifications. We offer SHOAR (Smart Healthcare Operations and Revenue Solutions), to help hospitals create an AI-transformed revenue cycle. SHOAR eliminates the need for revenue cycle staff to monitor payor websites for status updates, using our EHR expertise to build bots — digital employees that handle claims status or denials. These digital employees work 24/7, without error or variation, updating payor activity in real-time. In a recent pilot program with a cardiology practice, implementation of SHOAR’s AI reduced the staff workload by 50 percent.
This is a critical improvement in business operations. Combining our revenue cycle insights with AI improves the workflow, therefore standardizing processes for consistency and efficiency. SHOAR lets department staff focus on critical thinking and higher-value activities while they can follow up on specialty claims, ensure that claims are filed by deadlines and focus on continuous improvement. You can learn more about SHOAR and our work with autonomous systems here.
Sustainable, Scalable Improvements Drive a Better ROI
The pandemic has exacerbated many of healthcare’s chronic problems, including staffing shortages and systemic business inefficiencies. However, with better revenue management practices, healthcare organizations can help stabilize operations and make staff more productive. These are sustainable, scalable benefits that will continue to generate a return on investment, long after the pandemic has run its course.
To discuss your revenue cycle management and how to improve operations, talk to your Windham Brannon advisor or contact Danielle Epps or Valerie Barckhoff.