Hindsight becomes foresight: Three strategies for your 2021 revenue cycle

Healthcare Revenue Cycle

Hindsight is always 2020, especially during this past year. New demands spawned indelible changes in the way healthcare organizations manage their workforce, engage with patients and achieve efficiency. Facilities that were able to quickly pivot, change paths and implement innovative strategies were the most successful in 2020, and will lead the pack going into 2021. For example, our customers that rapidly set up remote revenue cycle teams reported the highest levels of staff efficiency, cash receivables and operational effectiveness ever witnessed for their organizations. 

A little change goes a long way. And these transitions are here to stay. In fact, I predict the next ten years will be profoundly different from the past decade for all healthcare revenue cycle executives. Now’s the time to learn our lessons from 2020 and embrace whatever lies ahead. Here are three success strategies to consider based on our collective experiences during the pandemic. 

Go remote, reduce complexity and address inefficiency

In 2020, the majority of revenue cycle leaders learned they could have it all: a remote workforce and greater efficiency. While transcriptionists, coders and CDI professionals were already working remotely, most other revenue cycle staff were not. That all changed this year. Now remote or hybrid revenue cycle teams are predicted to continue for the foreseeable future, maybe forever. 

Remote healthcare revenue cycle teams present a positive opportunity for productivity, effectiveness, recruitment, satisfaction and retention. When properly supported by technology, remote teams reduce wasted time around account decision-making and take more productive steps to collect cash. 

The secret to an effective remote or hybrid team is to simplify wherever possible. Healthcare revenue cycle processes aren’t easy. They are complicated and have become even more complex over time, which makes quick pivots extremely difficult for organizations to make. New technologies assist here and should be considered to flip the script on “how we’ve always done it” workflows. Automate as much of the process as you can so staff can work smarter, not harder. Here are two examples.

Follow-Up Staff:
Change system workflows to automatically present staff with the next most valuable account to work. Instead of bouncing between worklists to choose an account, staff should be presented with the next most valuable account. This simplifies work for staff and relieves managers from the onerous task of telling teams which accounts to work in a remote environment.

Patient access:
Check eligibility (pre-certification) across payers using technology and route cases to your registration representatives by exception—only those that fail checks. Working by exception reduces patient access workload by up to 50 percent. 

From a management perspective, highly effective remote revenue cycle teams also benefit from a leaders’ ability to see how well staff are performing in the remote environment and make necessary adjustments based on actionable information. This is an essential step to set up and maintain an effective remote or hybrid team. Current revenue cycle management systems are often lacking in this area to provide a high degree of specificity. For example, Epic can report when a specific staff member has followed-up on a claim, but lacks detailed insight regarding time spent on the claim, actions taken on the claim, the effect of that action, etc. Every step should be recorded and available for managerial oversight to truly manage and compare staff performance. 

Look at the big picture, maximize analytics

In Horst Schulze’s award-winning book, Excellence Wins, a story about improving the delivery of tea to hotel guests at the Ritz-Carlton is described. Guests were continually complaining about cold tea. Turns out the cold tea was due to backlogs in service elevators during housekeeping’s rush hour. It was a simple day-to-day problem that took careful analysis to identify the root cause and solve the great tea mystery. 

Healthcare revenue cycle leaders can do the same by maximizing their available analytics tools and keeping an eye on the big picture—customer service and staff satisfaction. 

Back-end problems like denials and recoupments are mitigated through careful analysis of front-end process data.

Managers make data-informed tweaks and adjustments in the process versus putting out individual fires every day.

Broader analytics provide a holistic view of performance. When you have the total swath of the revenue cycle, you can see performance at a high level and across all departments, which provides greater leadership insights. It also saves having to dig into each function’s system or dashboard.

Intelligence gleaned from analytics becomes even more valuable over time as strategies and tactics are improved for categories of patients, payers and situations versus individual cases. 

At the end of the day, it’s all about customer satisfaction. If you’re short sighted in your problem solving, you will miss opportunities, place blame in the wrong place and never get the best results. 

Metrics. Metrics. Metrics.

Success must be measured in order to be achieved. While we’ve always established and monitored KPIs in the healthcare revenue cycle, new benchmarks based on 2020’s impact should be considered. Knowing the plumbline of 2020 as we set new goals for 2021 is an important step. And when teams can’t keep up with volume spikes that may occur during tumultuous times, establishing outsourcing partnerships that can quickly scale is essential. These partners should also be held to metrics and remain accountable for the services they provide.

Go forth and succeed

Disruption from 2020 will get us to where we need to be ten years from now. Trends such as consumerism, the rise in self-pay and changing healthcare policy present huge opportunities to take our processes to the next level. Instead of hanging on to the status quo, 2021 is an ideal time to set new goals, reinvent processes and use technology to enable workflows in the healthcare revenue cycle.

The most valuable strategy for healthcare revenue cycle leaders in 2021 is to avoid letting perfection become the enemy of progress. You’ll be asked to pivot under pressure and snap decisions will be required. Informed rapid response may become your norm and your salvation.