Five Realistic Steps for Healthcare RCM Improvement for Pandemic Financial Recovery

According to Definitive Healthcare, hospital revenue losses stand as the biggest healthcare trend across the next year. In continued strategic recovery efforts across the industry, what else can healthcare leaders do to boost finances? Today, let's address five realistic steps for revenue cycle management (RCM) improvement during this next stage.

1. Get back to the basics.
   Healthcare facility leadership should focus on survival, maintenance and growth — in that order. Organizations need to realistically acknowledge that they cannot jump from survival to growth mode overnight. Concentrate first on operational sustainability. Maintenance and profits (growth) will follow. Once the direction is set and started, business office and RCM teams should proactively identify common barriers that will pop up, and list targeted actions that will eliminate or minimize each one's impact. The initial goal is getting business reignited, not returning "back to normal."
   
   
2. Target past A/R.
   Within this transition, the priority step during this time for hospitals, no matter the location, should be working down past A/R for account services provided. By doing this, business office and RCM staff clear out the work backlog for when full operational stability sustains. Within this process, healthcare organizations should also determine their top 10 claims denials, conducting a thorough root cause analysis. Denials often stem from missing information or inaccurate chart documentation, so ensure staff are properly re-trained to avoid repeat errors in the future. Follow up with tactics like chart audits and customized training for physicians on payer clinical documentation requirements.
   
   
3. Address claims holds.
   A major aspect of working down A/R is resolving claims holds — an unavoidable result of the pandemic and "great resignation" resource strain. With the emergence of COVID-19 and vaccinations came new CPT codes, diagnosis codes and grouper logic for categorizing and identifying patient care for billing and insurance purposes. Once CMS approved these updates, software vendors had to scramble to distribute and deploy their system updates for that logic across healthcare facilities. The effectiveness of this quick transition rests on the combined efforts of hospital IT and RCM teams for filing claims, pre-testing updates and working to understand how new rules and logic apply to their organizations. Health system business office and IT teams need to work jointly to get regulatory applies rolled out across facilities as soon as possible. This approach extends beyond pandemic-related codes as well, as healthcare facilities must prepare for the 2023 CPT codes release.
   
   
4. Strategize your plan of attack.
   Communicating effectively with both IT and business office teams, leaders should create a working document with a responsibility matrix. Conduct weekly meetings around it, and cover updates spanning new billing requirements (regs), changes in clinical documentation for billing, technology updates, summaries of adjustments in the local and national economies, along with new insurance coverage/payer requirements.
   
   
5. Utilize flexible support options.
   COVID-19's impact on balance sheets pushed significant cost reduction efforts. With healthcare facilities struggling with cash-on-hand, downsizing has ultimately been occurring across non-essential areas. On the IT front, hospitals should assess their support partners to ensure they thoroughly document their value and have multi-application expertise for flexibility. Look to agile programs like FlexSourcing, which drives down IT tickets over time to cut operational support costs.
   
   

The debt surge will continue to take a hold of the healthcare industry's direction for years to come. There will be no complete return to "normal." With the delay of claims processing comes a stall in payouts, directly hindering immediate cash flow. By combining these five realistic steps for RCM improvement, healthcare leadership can get facilities back on track with a nimble, viable approach.