Focus on financial processes and technology to support revenue cycle transformation during COVID-19 and beyond
September 20, 2021 •Streamline Health
By: Roberta Peters, MS, RHIA
Vice President, Solution Executive, eValuator™
Part two of a two-part series
People. Process. Technology. It’s the three-part framework through which healthcare leadership—or managers of almost any organization—can make adjustments to improve financial performance. What’s important to note is that for HIM and RCM management, no part of this triad is optional. Without embracing and addressing all three, healthcare organizations undercut their ability to ensure revenue integrity. For example, even the best and brightest revenue cycle staff can’t stay ahead of regulatory changes and optimize financial performance if they’re too busy handling manual tasks that are better suited to automation via technology. Likewise, simply using technology may be able to help you capture more revenue, but that doesn’t necessarily mean it’s accurate, compliant revenue. That’s where the cognitive judgment of experienced staff comes into play. Appreciating these interdependencies helps you establish realistic expectations and proceed with confidence.
The initial installment of this two-part series addressed the ‘people’ element. In this post, we’ll discuss the ‘process’ and ‘technology’ elements of the framework to foster financial growth and promote revenue cycle transformation.
“Most providers have an audit program in place to assist with confirming coding accuracy,
but the processes supporting this program are typically far from optimized.”
Rethinking quality review processes
A key process that often remains locked in place due to technical limitations is quality reviews of coding. Most providers have an audit program in place to assist with confirming coding accuracy, but the processes supporting this program are typically far from optimized. Retrospective audits, which occur after a claim has been released for billing, are commonly used for the simple reason that few providers have the time or resources to review coding prior to billing.
However, with the proper insight into which cases represent the greatest potential impact on financial performance, providers can leverage pre-bill reviews to maximum effect. Automated pre-bill coding analysis enables providers to identify which cases have substantial issues worthy of additional review, ensuring that reviews deliver optimal value with minimal impact on unbilled A/R.
With the use of automated coding analysis, your audit team is also relieved of many time-consuming tasks like manually selecting cases for review. And in a similar fashion, auditors are often forced to manually track and compile results in spreadsheets, wasting precious time & focus that could be better spent on auditing cases. Another example of process that’s best left to technology so your team can focus on the cognitive tasks that add real value to your revenue cycle.
When it comes to revenue cycle transformation, automated workflows are also critical—something that’s only possible with the help of technology. But not all technology is created equal, which is an especially important consideration for organizations currently using any combination of in-house and third-party resources. Having the flexibility to easily adjust workflows is crucial for providers hoping to optimize operations and productivity now while also being open to strategic changes later. Cloud-based tools are the new normal for giving providers the best of all options: dashboard views to monitor KPIs, simple tools to make adjustments as needed, and secure remote access to ensure all resources, internal or otherwise, can be leveraged to full effect.
“Stakeholders in HIM and RCM roles must be proactively engaged in
identifying ways to improve technology-enabled processes.”
Innovative solutions can optimize coding and ensure revenue integrity by applying thousands of proprietary rules to gauge coding’s impact on revenue integrity. This same technology also automatically routes cases based on custom thresholds, displays real-time key performance indicators, and provides coders with real-time narrative advice on what is in question and detailed corrections.
Identifying this technology should not be an exclusively IT-driven process. Stakeholders in HIM and RCM roles must be proactively engaged in identifying ways to improve technology-enabled processes that also support secondary goals like staff development as explained in part one of this blog series. With the right combination of people, process, and technology, healthcare organizations set themselves for revenue cycle transformation that transcends any uncertainties that lie ahead.
How Streamline Health can help
Streamline Health eValuator™ is a cloud-based platform that provides 100% automated analysis of inpatient coding and charge accuracy prior to billing. It analyzes and ranks each case in real time based on both the need for further review and financial impact of recommended corrections. Backed by automated workflows, robust reporting and market-leading expertise, eValuator enables you to identify and address coding issues before billing for optimized revenue integrity and improved financial performance.
To learn more about how Streamline Health eValuator can help your organization attract and retain top coding talent, visit https://streamlinehealth.net/evaluator-revenue-integrity/.
See for Yourself
As more providers are discovering, pre-bill technology is the key to optimizing revenue integrity and financial performance across all service lines. As the leader in solutions to optimize coding accuracy prior to billing, Streamline Health is helping providers establish a new normal that improves their bottom line despite these challenging times. To discover how we can improve coding accuracy and financial performance for your organization, contact Streamline Health today.