Sustainable, profitable positioning for today’s provider organizations hinges on the ability to capitalize on all revenue potential. The days of settling for 80-90 cents on the dollar are long gone as today’s provider organizations strive to increase margin within the framework of increased patient financial responsibility, the shifting payer reimbursement models and higher cost of labor.
Amid these changes, healthcare organizations face another significant challenge: unprecedented shortages of qualified billing staff and stiff competition on the recruitment front. Consequently, executives must not only achieve more with revenue cycle processes but must also have attractive systems in place that appeal to new hires and support staff retention for the long-term.
For Rebound Orthopedics and Neurosurgery, the team of physicians that supports the NBA’s Portland Trailblazers, the answer lay with implementing new technology-enabled workflows built on automation and effective intelligence. The right technology infrastructure helped the 75-provider, 16-location organization in Portland, Ore. and southwest Washington eliminate the practice of simply throwing resources at patient accounts and open claims and make informed, data-driven decisions instead of hiring more staff.
Effective Intelligence: The Power of Data-Driven Workflows
Data analytics has been a buzzword across the healthcare industry for over two decades now. And while many provider organizations have invested in some form of infrastructure to support “intelligence,” the question that needs to be asked is: Is the data making revenue cycle more effective?
Effective intelligence calls the user’s attention to the source of problems before they are obvious or stumbled upon, and doesn’t require a ton of experience or reliance on “gut.” It dives deeper into granular data that provide visibility into the effectiveness of each staff member and revenue cycle processes as a whole. With the right infrastructure of analytics and automation, provider organizations can answer key questions such as “Could I be overstaffed?” and “Who are my most effective team members?”
Without answers to questions like these, provider organizations have limited ability to identify process improvement opportunities and make the most use of existing staff resources. For example, Rebound Orthopedics’ goal is to reach the highest percentage of zero-touch claims as possible.
That means revenue cycle staff are doing the right activities and capturing the right up front that will result in the claim being processed and paid without human intervention.
Achieving that goal requires access to key information:
- How many claims are currently being paid without human effort?
- What is the reason for the manual work effort?
- How many claims are denied or require edits?
- How often are patient collections occurring post-visit?
- What are the root causes of denials and edits, and where can education improve staff performance?
- Where are financial clearance strategies falling short on the front-end, and what patient collection opportunities are missed?
Simply put, the higher a practice can drive its zero-touch claims percentage, the more likely the organization will get paid the expected amount in the shortest time which means fewer people will be required to manage the preventable denials and write offs later.
Taking Hold of the Big Picture of Effective Intelligence
The applications of effective intelligence are broad and should be applied holistically to address the full lifecycle of billing processes, starting on the front-end and extending to patient balance follow-up. At Rebound Orthopedics, data forms the foundation of this effort via a centralized data warehouse that brings together data from multiple sources—practice management systems, EHRs and workflow automation solutions.
The Rebound Orthopedics team is equipped to optimize revenue cycle through a framework that addresses:
Front-end financial clearance
Getting to zero-touch claims starts first and foremost with accurate pre-registration processes that promote upfront collection of patient payments. The right infrastructure of automation and analytics can improve the overall financial experience by keeping patients informed and engaged from the start. Front-office staff minimize avoidable denials by ensuring accurate documentation, insurance and demographic information is obtained upfront, which in turn informs the amount patients will need to pay.
Workflow automation and virtual communication tools are helping Rebound Orthopedics make the most of staff resources and gain needed transparency into a remote workforce. These tools automate manual tasks, speeding daily work and improving accuracy. The software “learns” over time which claims need attention first in order to maximize collections, and present daily priorities to the biller in precise order, rather than just doing the easy ones first on a hard day. The clear visibility into whether any given staff are following the specified daily order makes managing more rational and data-driven.
Back-end patient financial engagement
When patient payments are not collected on the front-end, mobile engagement tools meet patients where they are, and patient financial counseling services pick up the slack.
In addition to a more optimal revenue cycle, the effective intelligence solutions deployed by Rebound Orthopedics have also resulted in unforeseen benefits. The executive team now has visibility into how payers stack up across the organization’s revenue cycle on an apples-to-apples basis, with different RBRVS years normalized, and based on how the group is actually paid rather than the nominal conversion factor. Reporting tools provide immediate insight into which payors are managing to pay well below expected collections through contract terms that may have been missed relating to ancillaries, non-physician providers, assist fees, and strategic denials.
Today, Rebound is achieving better bottom-line performance with fewer FTEs. Zero touch claims that require no human intervention now account for 62% of total, and a closed balance net collection rate above benchmark at 98%.
The success that Rebound is having despite the compounding external challenges faced by all medical groups goes to show that revenue cycle strategies must morph to improve margin and make the most of available resources. Healthcare organizations can no longer afford to leave money on the table. Technology-enabled processes that draw on workflow automation and analytics can deliver more effective intelligence that drives considerable bottom-line improvement—and best positions providers for a sustainable future.
Physicians Practice| June 20, 2022