The healthcare revenue cycle comprises the entire spectrum of patient care, from scheduling to receipt of the final payment. Every core component of the process impacts the revenue cycle, and each needs to work in conjunction with the others to enable the hospital or practice to maintain a positive revenue flow and remain operating. However, the revenue cycle is a complex process, often filled with inefficiencies and revenue leakage. A revenue cycle assessment will help you discover inefficiencies and provide actionable insights for improving the revenue cycle and improving profits.
Revenue cycle management
Revenue cycle management involves the oversight and administration of all the processes involved with patient care through billing and accounts receivable. A strong revenue cycle management strategy requires detailed, up-to-date information to get a complete picture of financial performance. It should:
- Integrate disparate business departments and processes to streamline cash flow
- Automate routine tasks to reduce the amount of administrative resources needed
- Support a helpful connection between a patient’s clinical and financial experience
- Ensure compliance protocols are followed and filing deadlines are met to reduce denials
- Assist maximum recovery for providers through efficient and timely claims processing
There are many factors that contribute to the practice’s ability to maximize revenue and reduce the time it takes for patients to pay. That’s why it’s important to periodically look at all the factors and processes involved in the revenue cycle.
Importance and benefits of revenue cycle assessments
A revenue cycle assessment allows you to look closely at the processes, workflows, and procedures that feed into the revenue cycle and compare the metrics to industry standards. The results point out areas that might have issues that negatively affect the cycle so you can take steps to improve them.
According to a 2017 Change Healthcare report, more than $262 billion in claims are initially denied every year due to insufficient clinical information. Appealing those claim denials is costly and time-consuming, so it’s best to be proactive and make sure everything is complete and accurate before billing. Also, external healthcare audits from payors and regulators are increasing, so conducting periodic assessments — either internally or through a consulting company — can help find gaps and holes in the revenue cycle and determine where education of staff is needed before an external audit finds those problems.
Revenue cycle assessment best practices
Although your revenue cycle assessment will essentially be an audit of your practices, don’t label it as an audit because the term has negative connotations and may cause anxiety among your staff. Choose an experienced third-party consulting company to look at your revenue cycle. The consulting company should be on-site for observation and assessment. A complete and successful assessment requires a full understanding of the facility, its team members, and how the processes integrate with each other.
The assessment should look at:
- Contract review
- Scheduling and pre-arrival
- Patient access and financial counseling
- Mid-revenue cycle
- Business office: cash applications and denials
- Revenue cycle compliance
- Customer service
Actionable insights should include:
- Implementation of workflow redesign
- Leadership mentoring
- Quality assurance monitoring
- Report generation and discussion
- Corrective action planning with accountability
- Project management
Set up a schedule for regular revenue cycle check-ups. Some critical assessments (e.g., financial) should be done monthly, while others, such as SWOT (strengths, weaknesses, opportunities, threats) analyses, should be conducted annually.
Are you ready to assess your revenue cycle? Let TruBridge help.
Written by Jason Coffin
TruBridge VP, Professional Services