This year is already shaping up to be another challenging year for healthcare providers, and for those responsible for their revenue cycle. Reimbursements continue to decline while workloads for staff continue to increase—making it difficult to maintain profitability and keep a healthy revenue cycle.
However, many organizations remain slow to adopt revenue cycle management tools that can help them optimize revenue cycle management (RCM), according to a recent study released by the analyst firm Black Book. Among the findings:
- Four hundred of the 522 hospitals surveyed have adopted workable RCM IT plans and implemented new RCM systems over the last six years—an improvement since 2012.
- Yet twenty-six percent of hospitals started the year without viable, effective RCM solutions.
As healthcare leaders look to identify cost saving opportunities and generate stronger cash flow, RCM leaders can step up their game by focusing on optimized workflows and seeking an integrated solution.
Workflows: Efficiency at all costs
More than 70% of hospitals use their EMR or Practice Management (PM) solutions for RCM, and use multiple vendors for additional RCM activities. But lack of interoperability and data silos remain significant issues for many RCM leaders. Smaller providers may have less systems in place to manage, but even two systems that are not fully integrated will lead to inefficiency.
Healthcare providers must have one source of truth. To accomplish that, the work must be done in one system, to leverage that source of truth to the maximum degree. If a correction was made outside the system, it’s not efficient to import that correction manually back into the host EMR/PM system, for example.
The benefits of workflow optimization can be significant, but the execution requires expertise, time, and cooperation with providers, RCM partners, and, in many cases, the EMR/PM systems. You must have a good relationship at multiple levels to get that work done.
Start with the EMR/PM and integrate RCM
During an EMR/PM build, it’s natural for an organization to put considerable focus on clinical functionality. However, the line between clinical and financial data isn’t as bright as it once was, and a significant indicator of a successful go-live is providers’ ability to effectively manage payments and claims.
Providers upgrading or embarking upon a net-new EMR/PM implementation should make RCM a high and continuous priority in order to identify and mitigate any issues during the build. With an implementation of this scale, the impact on cash flow is always going to be a concern. New EMR/PMs often cause changes in charge capture and billing processes, and there is the ever-present risk that something will go wrong, leaving you unable to get charges out the door.
The key is having an experienced, proactive RCM partner. When implementing a new EMR/PM or adding RCM to an existing implementation, providers will face unfamiliar waters and potential changes to their IT, internal processes, or workflows. However, an experienced and actively participating RCM partner can make a huge difference.
A partner that knows your organization also helps your staff get acclimated, provides guidance, and ensures everyone stays accountable. A positive and fruitful collaboration allowed us to establish claim benchmarks and ensure that work-queue configurations were optimized to mitigate missing or lost claims.
MicroMD offers Integrated RCM with Availity
MicroMD works with Availity to deliver an integrated Revenue Cycle Management (RCM) solution that helps you keep your profitability healthy, reduce costly denials, and minimize days in accounts receivable. Producing cleaner claims reduces calls to the health plans and expedites payments. MicroMD and Availity RCM work seamlessly together to provide maximum convenience and flexibility by incorporating processes direction into your practice’s workflow:
- Secure, automated file transfers
- Professional and institutional claims submission (electronic and drop-to-paper)
- Auto-posting of remittance advice (835s) back to MicroMD
- Claim status (277U) posting with plain-language error messages
- Real-time eligibility and benefit verification from within MicroMD
- Edit/Error Management
- Analytics and Reporting
In addition, several additional modules are available to help you take results even further. Denial Prevention, EOB to ERA Conversion, Auto-Secondary Claim Generation, and Drop-to-Paper, are just a few examples of the powerful, integrated revenue cycle functions available from MicroMD, working with Availity.
Katrina Mack is a channel relationship manager with Availity. Availity is the place where healthcare finds the answers needed to shift focus back to patient care. As the nation’s largest health information network, Availity facilitates over 4 billion clinical, administrative, and financial transactions annually. The company’s suite of dynamic products, built on a powerful, intelligent platform, enables real-time collaboration for success in a competitive, value-based care environment.