David Gallegos from Change Healthcare discusses 5 signs an organization should consider partnering with an outside partner to support their revenue cycle management (RCM).
Are your revenue cycle management (RCM) staff and resources being stretched with the day-to-day challenges required to orchestrate claims, stay on top of regulatory changes and track payments? Are you trying to communicate more meaningfully with patients and collaborate with payers in ways you’ve never had to be before?
Chances are you answered yes to both of these questions. And you’re not alone.
Healthcare’s changing landscape is challenging us all, pushing RCM solutions and staff in particular to evolve beyond traditional processes. They’re being tasked to manage existing volume-based revenue streams and implement value-based payment models all while leveraging a very limited number of payer-agnostic RCM solutions.
We know leveraging data and analytics are key to maximizing the patient experience and achieving value-based contract benchmarks, but many healthcare organizations are really struggling to get there. For these organizations, partnering with a consultant may be just what the doctor ordered.
The following are five telltale signs an organization should consider reaching out to an outside RCM solutions partner:
1. Planning or in need of an organization-wide transformation
Making tweaks to workflow or processes is one thing; however, many of the changes occurring in healthcare today require big, organization-wide transformations that can change the very essence of a business. For example, entire workflows may need to be revamped, legacy technology may need to be updated and considerations need to be made for communicating with and including all healthcare stakeholders as part of RCM.
Even seasoned RCM staff may be overwhelmed by these changes, which is why an experienced consultant partner who can step in and offer leadership, guidance and management skills may be the answer. Consultants typically study processes, evaluate systems and tailor a plan specific to the organization, helping an organization achieve its goals.
A good consulting team can bring the expertise, experience, and sheer manpower needed to implement an initiative, allowing an organization to remain competitive. They can also help an organization incorporate agility into its infrastructure and culture, so they are prepared to continuously embrace change and meet future challenges head-on.
2: Looking for a fresh approach and perspective
Many organizations try different approaches and strategies to meet their goals only to find that the solutions weren’t right for the organization or implementation didn’t go as planned. However, they don’t always have the right perspective to get past these hurdles.
Because internal leaders and staff are ultra-close to the day-to-day business processes and systems, they often can’t see how “normal” or minor inconveniences affect employee morale, productivity and customer satisfaction. Moreover, many processes and systems used by organizations were built and/or implemented by current staff—who understandably have emotional connections to what is being used. Any changes to these processes or tools could be perceived as a critique or even a threat to their jobs.
With so much at stake, these organizations need a fresh approach to meet the industry’s evolving needs and make necessary improvements. By partnering with a consultant familiar with industry trends and benchmarks, organizations can quickly identify areas for improvement that can yield immediate benefits.
3. Lacking expertise in specific areas of RCM
Healthcare organizations are facing challenges new to the industry, particularly with value-based reimbursement models on the rise, patient consumerism and growing out-of-pocket expenses. Many providers don’t have the expertise to manage these functions, and feel understaffed and unprepared, in addition to lacking the right tools to effectively communicate with and collect payments from patients. The use of external expertise and solutions has become commonplace as healthcare navigates the shift from fee-for-service to value-based care.
Healthcare providers can more easily navigate these unchartered waters by working with a consultant partner who not only has the necessary expertise to manage these functions but also understands which tools are most effective in helping the organization meet its goals.
4. Don’t have the manpower to take on additional work
Making transformative changes to an organization requires redesigning business processes, updating or replacing systems and revising policies and procedures, among other things. Yet, most organizations already are operating on lean budgets as reimbursements shrink and costs grow. Typically, staff are stretched to the max and don’t have the bandwidth to take on additional work such as process improvement initiatives.
Healthcare organizations lacking the staff to make necessary changes can turn to consultant partners to do much of the heavy-lifting. This allows the organization to shift with the industry and make key changes while not overburdening staff.
5. Having trouble reducing backlogs
Coding, submitting claims and fighting denials are important functions in RCM. When new processes or technology are introduced or when departments are understaffed or lack the right resources, this can lead to backlogs. Overall, backlogs slow the flow of revenue and affect the organization’s financial health.
Healthcare providers can reduce or eliminate their backlogs by engaging a consultant partner who will roll up their sleeves and work side-by-side with the organization so they can better manage the many aspects of the revenue cycle.
Is It Time to Seek Help?
Take a look at your organization and consider these signs. Did you identify with some, most or all of them? It could be time to explore outside expertise, solutions and resources to successfully tackle these new demands.
David Gallegos is Senior Vice President of Consulting Services with Change Healthcare Consulting. He is responsible for leading the efforts to engage clients and provide services that optimize business operations, reduce costs, improve quality, and increase consumer choice, access and satisfaction.