In healthcare revenue cycle management (RCM), technology is playing an increasingly crucial role in streamlining processes and enhancing compliance. Here, our team sheds light on integrating technology with a consultant’s perspective to simplify processes, improve compliance, and significantly enhance RCM.
Electronic Medical Records (EMRs) and Electronic Health Records (EHRs)
EMRs and EHRs are the digital platforms used to store and manage patient information, including information about procedures and treatments. Many of these systems boast advanced technology features, which can enable operations teams to automate some of the manual work. If not already, leveraging your EMR or EHR’s automated systems to the fullest should be part of your foundational RCM strategy. Doing so can transform coding practices, minimize errors, and bolster compliance.
Become a Power User of Your EMR
First, every EMR system is different, and understanding these differences is key to maximizing their potential. Strategic use of EMRs requires understanding of these nuances.
You can further ensure your organization is getting the most of your EMR by customizing its settings. While it’s common knowledge that you can modify the factory settings of an EMR to include specific rules, many organizations fail to prioritize this motion. Meanwhile, organizations that maximize these modifications relieve staff from memorizing different rules for various insurance providers and doctors, and remove potential for errors.
Next, as rules change, another step that often falls down the list of priorities is updating your EMR settings to ensure compliance with the latest regulations and payer requirements. Failing to do this can result in inconsistency, errors, and denials.
Supplementing with Clearinghouse Integrations
Don’t stop with your EMR. You can also use your clearinghouse to ensure all coding and billing rules are followed, relieving your staff of repetitive tasks. Adding extra layers of rules and alerts to your clearinghouse in addition to your EMR ensures that any gaps left by the EMR are covered, providing a comprehensive safety net for coding accuracy.
You can also improve sophistication in your tech stack with clearinghouse rules and alerts. If you have these set up, your team has more coverage and will submit fewer claims with errors. These rules can be set up through the entire revenue cycle from patient registration through to claim submission. And they help ensure that each step is covered, and any errors are caught early.
Prevent Denials with Technology
More advanced automations can further prevent human errors and conduct checks and balances throughout the revenue cycle. While it takes discernment to choose optimal processes to automate, doing so reduces the chance of denials and lost revenue. An example of useful automation: claim scrubbers, which flag potential errors before claims are submitted.
Another important tool is integrations. Automated checks can be easily integrated into existing EMR and clearinghouse systems, providing real-time feedback and ensuring compliance with coding standards. With integration, you can ensure that your EMR, clearinghouse, and other systems work seamlessly together to provide comprehensive protection against human errors.
Denial Analysis & the Importance of Regular Health Checks
To effectively analyze denials, RCM leaders can use the ‘rule of three.’ This involves sorting denials by the following root causes: payer issues, human errors, and system glitches. These categories help inform targeted solutions.
But how can leaders connect the dots between denials and these root causes?
By regularly conducting more comprehensive ‘health checks’ of your full revenue cycle.
Health checks should be in-depth examinations of your RCM processes, looking at everything from various perspectives. This is like thoroughly inspecting a car before purchase, ensuring no detail is overlooked.
Waiting until problems become severe can lead to reactive management, which is often stressful and less effective. Regular health checks help you stay ahead of issues, allowing for timely interventions. But what does an effective health check look like?
Start by gathering data on charges, payments, adjustments, and remittances. This data should cover at least a year to provide a comprehensive overview of your RCM health. Then, analyze your data from various angles. This involves setting up your Key Performance Indicators (KPIs) and regularly reviewing them to identify trends impacting your organization. KPIs that matter most to your organization could include metrics related to claim denials, payment processing times, and overall revenue.
Comparing your data against historical and industry benchmarks can uncover patterns and anomalies. This helps in identifying both positive and negative trends affecting your KPIs.
Health checks enable proactive revenue cycle management, save yourself and your team significant stress, and help in turning performance around quickly and efficiently. Learn more about our RCM Health Check here.
Proactive Denials Management
Priorities will emerge depending on the results of a health check or denial analysis. Here are some potential action items informed by the results of your analysis:
- Ongoing Training: Provide ongoing education and support for coding teams to keep them updated on the latest regulations and best practices.
- Robust Support Systems: Implement robust support systems to help coding teams resolve issues quickly and effectively, reducing the time spent on appeals.
- Collaborative Efforts: Foster a culture of collaboration across departments. Regularly bring together stakeholders from coding, billing, registration, and other areas to discuss challenges and solutions.
These are potential analysis-informed activities your organization may look to prioritize in wake of identifying the root causes of denials and other RCM issues. But, it’s always best to get clean claim submissions the first time, so it’s never too early to implement these as best practices even before analyses are complete.
Other Ways to Improve Your Revenue Cycle
Sometimes, an external perspective can be invaluable in uncovering hidden issues and suggesting effective solutions. If seeking such a partner, make sure you engage experts who provide a consultative approach, offering recommendations based on data analysis.
We also recommend staying updated with the latest technological advancements in RCM. This includes understanding and implementing AI and machine learning to streamline processes and enhance efficiency.
Finally, you can only ensure that you continuously improve revenue by ensuring that your team is continuously learning and adapting to new regulations and technology. This adaptability will keep your organization ahead of the curve.
Conclusion
Healthcare RCM requires constant vigilance and proactive strategies to ensure optimal performance. Integrating technology and a well-coordinated team is essential for optimization. By customizing EMR capabilities, leveraging automation and AI, and taking a proactive approach to denials management, healthcare organizations can enhance compliance, reduce errors, and improve overall efficiency.
We hope you found these insights valuable and look forward to exploring more strategies and innovations in future articles. If you’re looking for help with managing denials, request a demo our denials management solution here.
