As margins are increasingly strained in the healthcare industry, providers are increasingly focused on creating cost-effective options to offset the changes of greater expenses and decreasing income.
Optimizing RCM or revenue cycle management through a structured business excellence model allows both small and large healthcare providers to restructure and streamline their processes. Using a four layer approach, providers can implement strategic changes that work together to optimize operations today, as well as in the future.
The process of implementing business excellence in a healthcare setting includes all aspects of the operation. This includes patient satisfaction, quality assurance, technology, and the training of the team to maximize the benefits of the system.
Building in Quality Assurance
Quality assurance begins with streamlining and correcting any problems that exist with medical coding. Errors in medical coding can lead to a denial of about one in ten claims, which cost the provider both time and money in correcting and resubmitting the claim.
The increasing scrutiny from payers on claims compounds any problems or inaccurate practices by the provider. Implementing quality assurance measures reduces the problems of under-coding, which creates a loss in revenue. It also addresses the problem of over-coding and the associated penalties and compliance problems associated with these types of errors.
Quality assurance builds in standard operating procedures or SOPs, completes ongoing staff training, and develops coding standard checklists that are used on all claim submissions. Digital processes and tools are effective at streamlining the quality assurance process and creating ways to evaluate and assess RCM practices on and ongoing basis.
Adding Automation
In the process of building quality assurance procedures, some aspects of RCM are ideal for automation. Using new technologies such as machine learning, artificial intelligence, and robotic process automation saves both time and money in processing claims.
Automation using technology also eliminates the risk of human error in these processes. Freeing up staff to work on processes that cannot be automated also helps relieve the pressure on overworked departments, particularly during a time of high volume claims.
Studies show that automation can save millions of dollars for large healthcare facilities while also benefiting small, independent healthcare services. Upgrading to the latest in technology across the entire revenue cycle, from pre-claim to medical coding to payment posting, is essential to leverage the benefit of automation.
Analysis of Data
Creating quality assurance and automation allows healthcare facilities to continue to collect data on their processes. In using data analytics and identifying areas of concern in the system, the healthcare facility can optimize its performance on an ongoing basis.
Big data analytics also provide insight into potential red flags on some claims, allowing the healthcare facility to prioritize processing specific claims over those that are likely to resolve on the first submission.
Staff and Business Excellence
Staff training at the healthcare facility is the overarching layer of business excellence. If the staff is not able to use the systems fully or is overworked or overwhelmed with the new technology, there is no gain.
Training the staff on how to use the technology, streamline their processes, and increase their job satisfaction is critical. Demonstrating to support staff that the healthcare facility is working to optimize their tasks helps to both retain current staff and attract new employees in a very challenging market.
Building business excellence is no longer an option for healthcare providers. Using a strategic approach to adding the four components of business excellence creates a positive change for any provider.