What You Should Know:
– The KLAS Revenue Cycle Management Summit 2024 brought together 117 revenue cycle management (RCM) leaders to address pressing challenges, explore emerging technologies, and enhance cybersecurity in healthcare.
The KLAS Revenue Cycle Management Summit provided healthcare leaders navigating the evolving RCM landscape with practical solutions and best practices for optimizing revenue cycle operations.
Top RCM Challenges and Solutions
Summit attendees identified several critical challenges impacting RCM, including:
- Denials Management and Prevention: Rising denial volumes, particularly from preventable denials, and longer processing times are straining resources and impacting revenue.
- Automation and Work Prioritization: Effectively leveraging technology and prioritizing tasks amidst increasing claim volumes and evolving regulations is crucial.
- Staffing Challenges: Finding, retaining, and engaging skilled RCM professionals remains a significant hurdle.
To address these challenges, attendees recommended:
- Strategic Payer Partnerships: Foster collaboration and transparency with payers through regular meetings, shared goals, and data-sharing initiatives.
- Denials Prevention: Focus on front-end processes like eligibility verification, prior authorizations, and accurate documentation and coding. Utilize technology like real-time insurance discovery software and ambient listening solutions to improve accuracy and efficiency.
- AI-Powered Automation: Implement AI to assist in denials management, coding accuracy, and prior authorizations. Leverage rules-based automation for increased accuracy and efficiency.
- Staffing Strategies: Offer competitive compensation, flexible work arrangements, and invest in training and development programs. Cultivate a positive work environment that prioritizes employee engagement and growth.
Technology Adoption for RCM
The summit highlighted the importance of technology in optimizing RCM. Attendees discussed the current and future adoption of technologies such as:
- Ambient speech recognition: Reduces documentation burden, improves accuracy, and automates coding and billing processes.
- AI and machine learning: Automates various RCM tasks, improves accuracy, and identifies patterns and trends in data.
- Robotic process automation (RPA): Automates repetitive tasks, enhancing efficiency and accuracy.
Key recommendations for successful technology adoption include:
- Stakeholder buy-in: Secure support from physicians, IT, operations, and executives.
- Problem-centric approach: Clearly identify the problem and select the technology best suited to solve it.
- Thorough evaluation: Evaluate vendors carefully, leverage third-party insights, and conduct pilot projects before full implementation.
- Strong governance: Establish a governance structure to ensure technology projects align with business goals.
Cybersecurity in RCM
The summit emphasized the growing threat of cybersecurity breaches in healthcare. Attendees discussed the impact of the Change Healthcare breach and shared preventive measures, including:
- Real-time alerts: Implement alerts for changes in electronic funds transfers (EFTs) to detect fraudulent activity.
- Access restrictions: Restrict EFT access during administrative data changes.
- Enhanced validation: Reinforce validation checks during user registration to prevent synthetic IDs.
