Revitalize Profit Margins By Fixing Broken Processes

By Bruce Orcutt, ABBYY

In today’s climate, healthcare providers must protect their profit margins and obtain every dollar that is owed to them by insurance companies. Enhancing operational efficiencies and streamlining administrative processes can go a long way in reducing denials and minimizing the amount of re-work involved in billing workflows.

Scheduling and patient collection processes are key for reducing denials. Common occurrences that can lead to bottlenecks and inefficiencies include not fully gathering relevant patient information, not verifying insurance, verifying insurance multiple times, or utilizing the incorrect billing codes upon initial submission. With all the possible root causes, healthcare leaders need advanced solutions that can enable them to identify where their bottlenecks are and which processes are costing them money.

Revenue Cycle Processes Are Growing More Complex

Revenue cycle processes typically involve at least eight steps, from a patient account being created to a claim being submitted to a provider being paid. We’ve even seen some healthcare providers have as many as 200+ steps in their revenue cycle processes. Not only do these workflows involve many steps but they also involve many different technology platforms and systems of record. This means several dashboards and logins to navigate and manage.

We’ve seen some providers have 30 or more back-end technology platforms that are a part of their revenue cycle process. Each of these systems manages a single component of the workflow, form scheduling and admissions, financial clearance, physician documentation management, coding and acuity capture, claim processing and payment. Each of these systems produces reports that offer visibility only into the specific component of the process which it manages. The problem is that those individual dashboards do not provide visibility into the revenue process as a whole. They cannot provide insight into how things are happening or why they are happening. Additionally, with this approach, time to results is slow and the cost is high.

It’s often challenging to identify the root cause of revenue cycle inefficiencies without having the right tools. Traditional approaches to measuring the health of revenue cycles in a healthcare setting often involve multiple dashboards, complex reports, on-site observation tools, staff interviews, or extensive teams of business analysts and database managers analyzing the numerous dashboards and reports from each system. These approaches are often insufficient and sometimes entirely unfeasible given today’s largely remote environment.

Being Data-Driven Is Key To Reducing Denials

One of the most effective ways to enhance healthcare provider revenue is to reduce denials from insurance claims. High denials rates often involve a significant amount of re-work in re-submitting claims and going through each process step over again to identify where steps were missed, correct process mistakes, and collect the necessary information.

The majority of current analyses into denials are very retrospective. One of the most effective ways providers can reduce denials is to become more proactive and data driven. They have to be able to answer questions such as: what is our denial rate? What codes are payers denying? Does the issue lie in coding, billing, scheduling, or patient information collection processes? Getting to the root cause as soon as possible is necessary.

It’s much easier to get to the underlying cause of process inefficiencies when processes are measured and evaluated. Doing so helps enhance compliance and ensure that all necessary process steps are followed, from verifying insurance at the time of scheduling to collecting all relevant patient information up-front to entering the correct billing codes upon initial submission.

Revenue cycle processes are complex. With data-driven strategies, providers can attain in-depth visibility into their operations, effectively manage business-critical workflows, and optimize revenue cycle processes.

How Can Providers Attain End-To-End Revenue Cycle Visibility?

When providers only utilize stand-alone back-end systems, it can be challenging to answer the following questions: how many times did an account get touched to produce a claim? What were the true cost and gross margin for a patient’s visit? Are administrators entering charges and codes correctly along every process in the revenue cycle? Enhancing revenue processes, and subsequently maximizing profit margins, requires having the right tools to answer these questions and attain end-to-end visibility into how processes are truly performing across every dimension of revenue cycle operations.

With advances in process mining and process intelligence technology, healthcare providers can attain a level of depth and granularity in their revenue cycle visibility that was previously unattainable. Driven by AI and machine learning technologies, process intelligence solutions can pull data from any existing technology system to create a holistic view of revenue cycle operations in real time. Providers can see the big picture of their entire revenue cycles, from scheduling to billing to claim submission to payment.

Leveraging the data that already exists in revenue cycle systems, process intelligence automatically reconstructs all processes exactly as they were performed. These solutions pull data from any healthcare system of record (such as EHR, ERP, and CRM) and connect the data from each of these systems to tell a complete story that provides granular visibility into every facet of revenue cycle operations.

We’ve found it’s not uncommon for providers to guess that they are around 95 percent compliant with their policies, and then come to find they are only 75 percent compliant. It’s often difficult to determine the degree to which processes are being followed when only having visibility into individual components of the process.

Traditional methods of evaluating compliance and measuring process efficiencies often include teams of data scientists, financial analysts, or IT specialists piecing together several individual reports from individual dashboards across the revenue cycle ecosystem. These solutions often involve significant time, resources, and typically don’t offer a complete view of operations. With process intelligence solutions, providers can increase process efficiencies even with a distributed workforce, remote teams, and multiple systems of record.

In revenue cycles alone, there are over 500 processes that process intelligence solutions can be applied to. Advancements in technology are empowering healthcare leaders and administrators, regardless of their specific specialty or function or technical background, to take greater control of their processes.

Making The Biggest Impact

During the disruption caused by the pandemic, healthcare providers have stepped up and gone to great lengths to serve and support their patients. They deserve to recoup every dollar that is owed to them by insurance companies. Dollars that will continue to enable them to serve more patients, offer the best care, and make the biggest impact. With the right technologies, providers can enhance process efficiencies in their revenue cycles, reduce their denial rate, save on costs associated with re-work, and enhance their profit margins – enabling them to make an even greater positive difference in patient lives during a time when it’s most needed.

About The Author

Bruce Orcutt is Senior Vice President of Marketing at ABBYY, a Digital Intelligence company. He advocates healthcare organizations use AI enabling technologies to get a unified view of their people, processes, and data.