Three New Perspectives on the Revenue Cycle

By nThrive | Posted: 03/21/2018

According to the Boston Globe, several well-known hospitals have reported significant declines in profits during the 2016 fiscal year. Among them, Partners Healthcare, New England’s largest hospital network has reported a loss of $109 million. This struggle to stay in the black will only intensify for hospitals of all sizes following the establishment of value-based care. In order to survive, health care organizations must dramatically rethink their approaches to patient access, claims processing and quality of care. For one, it is becoming increasingly difficult to track success within this model, and few providers have the technology necessary to track and analyze the quality metrics required, making it even harder to get paid.

Now is the time for providers to make some serious changes in order to drive revenue and optimize cash flow. But where do you begin when there are efficiencies to be gained across the cycle?

Consider a holistic approach.

“Recent health care trends have made it imperative that health care organizations drive revenue and accelerate cash flow in a sustainable way. Yet, relying on a number of different partners to manage singular aspects of the revenue cycle – as is status quo for many health care providers – invariably results in a lack of standardization across the systems that triggers billing bottlenecks, slows cash flow and impairs quality of care,” nThrive’s own Steven Huddleston, President and Chief Client Officer, explains in a Becker’s Healthcare RCM Tip of the Day.

Providers that utilize one-off or “single point” solutions for singular sections of their revenue cycle are missing significant efficiencies that may be gained from a comprehensive solution. Worse, those applying singular solutions too often find themselves operating in silos and applying disparate solutions, which not only results in a loss of interoperability, but it may actually aggravate the problem and deliver only marginal results.

“Consider bringing on a single vendor that takes a holistic approach to the revenue cycle — incorporating solutions that span the entire process from patient access to complete reimbursement. This way, you’ll eliminate the administrative burden associated with dealing with multiple vendors and will be assured that every component is optimized and plays well with the next,” Huddleston continues.

A Patient-to-Payment℠ solution, one that spans the entirety of the revenue cycle, is imperative to identify business issues and work smarter at every stage in the cycle. It gives providers the tools necessary to make more informed business decisions, provide better quality care and guarantee the positive ROI that CFOs are after.

Unfortunately, many providers are only now discovering that many of the skills and technologies necessary to optimize their revenue cycle are beyond the capabilities of internal staff and traditional EHRs. Savvy providers are turning to third party solutions to ease the burden. So, what do you look for when it comes to bringing a partner on board?

Ensure that the provider you select has the experience necessary to provide strategic insights.

RCM providers with knowledge and expertise of the entire revenue cycle will be able to integrate knowledge across the entire spectrum, enabling innovation and improvements that can’t happen otherwise. The team at nThrive, for example, is comprised of revenue cycle management experts, each averaging 16 years of industry experience, who have the knowledge to cut through the clutter and pinpoint actionable areas of improvement. Don’t seek a vendor, a third party that will implement its solution and “set it and forget it” when it comes to your issues. Ideally, your RCM vendor will act as a strategic partner – one that truly understands your business processes and can identify strategic solutions.

“A true RCM partner will do more than a traditional “vendor” would when it comes to your revenue cycle. Rather than simply addressing the issues that you are aware of, they will act as a strategic partner, using their industry expertise to analyze trends and identify repetitive or outlying issues that you likely didn’t even know were there. The savviest partners will aim to fully understand your business processes and be able to pinpoint the root business issue and identify actionable areas of improvement within your existing frameworks, enabling you to work smarter,” Sloan Clardy, Chief Strategy Officer at nThrive, explains in his latest Becker’s Healthcare RCM Tip of the Day.

The right RCM partner will have technology that easily integrates with your existing systems and will customize a solution to fit your specific needs and KPIs. But perhaps even more importantly, the right RCM partner will put your interests first.

Look for a RCM provider that is independent.

“The Health care industry is complicated enough without having to wonder if your revenue cycle management company is putting its own business first. When choosing an RCM partner, be sure to consider how the company is bound to the interests of a payor or provider system. Only an independent partner will be able to provide unbiased guidance and act as an advocate on behalf of its clients,” Clardy tells Becker’s.

Advising a hospital system on how to improve its revenue cycle cannot effectively be directed from a biased point of view. That’s why an independent provider is the best choice for objective recommendations that are not self-serving, financially motivated or tied to a singular outcome or viewpoint. For example, an independent provider may identify data solutions that reveal payer reimbursement trends and discrepancies.

For more tips on choosing the best partner to transform your revenue cycle “10 Signs Your Revenue Cycle Needs a New Perspective”.