rcm process gaps

Revenue Cycle Management (RCM) is an end-to-end process that begins at dispatch and flows through to the end of the life cycle of the account. In short, it touches every aspect of your business operations.

As RCM becomes increasingly complex, gaps in your process can result in significant revenue loss and cash delays. While successful billing operations often address the most common gaps such as incomplete level of service documented at dispatch, missing prior authorization, lack of documentation, and inability to account for payor nuances, to name a few, there are numerous others than often go unnoticed and, if left unchecked, can lead to significant downstream issues with negative financial impact. Does your organization have the skillset and bandwidth to objectively assess your revenue cycle processes and comprehensively identify potential pitfalls?

Revenue Cycle Assessment

An assessment of your revenue cycle process should be categorized into three key groups with a focus on answering fundamental questions to identify opportunities: People, Process, and Tools and Technology. The following questions serve as an initial guide to determine whether your existing operations will support your long-term revenue cycle goals or whether your organization may need to augment certain areas:

People

  1. Do you measure the quality and productivity of your team and leverage it for ongoing education and training?
  2. Are your clinicians providing quality clinical documentation to support accurate billing?

Process

  1. Are there gaps or inefficiencies in your RCM process contributing to revenue loss or delayed cash?
  2. Is your workflow documented in formal procedures?
  3. Do you have appropriate change management processes in place?
  4. Has your RCM workflow been optimized to include the most efficient and accurate billing and collection processes?

Tools

  1. Have you successfully introduced automation using third-party vendor tools?
  2. Do you have a vendor management program in place to monitor and manage your vendor partnerships?
  3. Do you have sophisticated reporting to track key performance indicators (KPIs) and are you able to quickly adjust course when needed?

Key Performance Indicators (KPIs)

It is imperative to evaluate revenue cycle KPIs in parallel with an operational assessment. Unlike traditional business performance metrics, KPIs must be both impactful and relevant to the business. They should be actionable, necessitating access to real-time data, comparable, ensuring they align with either internal best practices or industry benchmarks, and aspirational when appropriate for the revenue cycle. The top five KPIs that drive cash flow are the following:

  1. Daily Cash Deposits, which provide insights into your business’s overall cash flow trends over time.
  2. Inventory Reporting, which identifies “stranded” cash flow and serves primarily as a production management and reconciliation tool, enabling effective reconciliation and a disciplined approach to managing unbilled transports.
  3. Cycle Time, which identifies process-related gaps or challenges with payors and internal processing controls, facilitating continuous process optimization and cash flow acceleration.
  4. Level of Service & Payor Mix, which reveals material shifts in payor mix that will influence payments both in terms of cash performance and timing.
  5. DSO & AR Aging, which serves as an A/R health indicator by identifying performance outliers and surfaces negative and positive trends that correlate to significant events such as payor mix and cycle time change.

Further, a business intelligence program with robust reporting on KPIs is necessary to help your leadership team keep an eye on trends and issues that impact your business while facilitating deeper insight into opportunities for process improvement.

Once negative outliers are identified, an action plan must be quickly implemented to realign performance with targets and/or industry best practices. Is your organization measuring and positively affecting the most important KPIs?

Revenue Cycle Process Improvement

Integra Connect delivers a Six Sigma approach to process improvement and offers a full range of services from consulting to fully outsourced RCM. Our expert team analyzes your existing billing operations, identifies potential revenue gaps and process inefficiencies, then delivers an action plan to eliminate redundancies, streamline operations and improve profitability.

Revenue Cycle Process Improvement

What makes our solution different?

We offer a fully integrated approach, immersing our team into your EMS service operations, to holistically understand your unique business and develop personalized process plans. Our team of experts were born in the EMS space and have over 20 years’ experience in the EMS market. This results in streamlined operations, reduced errors, increased compliance and increased profitability. Key service offerings include:

  • Deep-dive into process analysis to identify areas of opportunity.
  • Expertise in “lean” processes, ensuring all recommendations increase efficiency and profitability.
  • Laser focus on identifying redundancies within EMS revenue cycles.
  • Recommendations that integrate into existing processes, supporting faster and more sustainable adoption.
  • Proprietary technology platform to assist our team.
  • Execution timelines to ensure accountability across all key performance measures to optimize results.