Reviving RCM Operations to Enable Value-Based Care Success

April 26, 2019

In the fee-for-service era, the typical revenue cycle mirrored a patient’s office visit and focused on obtaining appropriate payment for services delivered along the way. The emergence of new, value-based payment models is transforming that approach and, as one large urology group in the Carolinas discovered, the existing, fee-for-service approach to revenue cycle operational were no longer optimal. The practice reached out to Integra Connect to help them uncover and prioritize improvement opportunities within its existing revenue cycle, ultimately identifying talent management; documentation gaps; administrative workflow burden; and lack of forecasting capabilities as the top “high-impact” pain points.

To augment the practices existing fee-for-service revenue cycle management with the key activities needed to fuel its value-based care transition, Integra Connect:

  • Implemented a new engagement model between the billing and clinical teams to support contract compliance; tracking of patient quality measures; and performance management;
  • Redesigned workflows to optimize efficiencies and incorporate value-based activities, including drug selection analysis, revenue modeling and documentation gap mitigation; and
  • Introduced suite of analytics to model revenue upside potential and downside risk; track ongoing revenue cycle performance; and target areas that negatively impact cash flows, such as documentation gaps.

By transitioning RCM operations to Integra Connect, the practice accelerated its growth, removed administrative burden and increased control over both fee-for-service and value-based care performance. After the first six months, the practice had already increased net collections by 21 percent, reduced rejections by 48 percent, and realized a 29 percent reduction in denials.