Every step in the patient care process, from the moment an individual presents to a healthcare setting or makes an appointment to be treated, to the final step when payment for treatment is received, is a part of the revenue cycle. This means that an optimized RCM process is essential for patient care, payor satisfaction and a financially viable healthcare practice.
Regardless of the size, structure, location or type of services provided, all entities within the spectrum of healthcare need to have an RCM process established to collect payment for care across four principal payment methods:2
There are several distinct functions in the healthcare revenue cycle that feed into effective RCM and help healthcare organizations grow and maintain their revenue streams:
Ever-evolving guidelines are established by payors regarding what they pay for, how much they will pay and when. These guidelines are frequently modified and new ones are introduced regularly, leaving healthcare organizations scrambling to keep up with the latest regulations.
Legislative decisions are made by the government regarding healthcare delivery and funding. These decisions impact various aspects of care and revenue management, from how services are prescribed and delivered to which ones are eligible for reimbursement or coverage.
Economic shifts that affect patient utilization, fluctuating demands for particular types of services, and competition within industry sectors. These larger market changes are typically coupled with patients’ ability or inability to pay for their share of healthcare costs.
Business performance as it relates to an organization’s own productivity, efficiency and quality of patient care. The effectiveness of an organization’s RCM depends heavily on processes and performance metrics, both of which influence billing and payment operations.
Most Post-acute care (PAC) agencies — including therapy, home health, hospice and skilled nursing facilities (SNFs) — are smaller, less consolidated and have fewer government-provided incentives than accountable care organizations (ACOs) and larger healthcare systems..
Due to tighter budgets, many PAC agencies struggle to invest in back-end office technologies, which means they have fewer opportunities to update or replace legacy management systems and may continue to rely on manual administrative functions.
High turnover and staffing concerns plague the entire healthcare industry. However, the smaller models of most PAC businesses are at a distinct disadvantage as they have more trouble filling in gaps and getting new employees trained fast enough to keep up with demand.
While this change impacts all healthcare systems, PAC agencies are being foundationally challenged by this newer delivery model that shifts priorities from simply paying for services rendered, to being paid for the results of those services and how they impact patient outcomes.
Read our blog, How Rehab Therapy Practices Can Make The Shift To Value-Based Care, to find out how your organization can leverage the benefits of value-based care.
Medicare is the nation’s largest single purchaser of post-acute care services and the primary driver of value-based care.3
Responding to market changes and evolving patient demands, CMS is pressing post-acute care agencies to provide robust, well-structured services in the most efficient way possible. The number of referrals agencies receive over the next several years and the type of contracts they can garner will largely be influenced by a healthcare agency’s ability to meet these demands and show the clinical results of their high performance.
Within this framework, several developments have occurred or are expected to take place, which will have a significant impact on organizations that derive most of their profits from Medicare reimbursements.
Proper RCM affects more than how clinicians and administrators receive compensation for their work. It also allows healthcare organizations to grow, improve, adapt, and compete with similar entities by establishing themselves as providers and employers of choice.
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Ultimately, an effective RCM process results in higher quality care for patients and improved financial health for your organization. Here are a few distinct benefits you can expect to gain from optimizing your RCM:
The post-acute care market is evolving at a rapid pace. Time and expertise are of the essence — healthcare organizations need a reliable process that enables them to optimize their revenue cycles and align with demand.
An optimized RCM process can help healthcare organizations:
Optimized RCM helps accounts receivable (A/R) teams save significant time and effort. Employees should also be able to quickly determine a patient’s insurance status and copay requirements, further ensuring proper reimbursement for Medicare patients and other care recipients.
Optimized RCM is cross-functional and provides transparency into clinical workflows to ensure thorough coding and timely billing. It shouldn’t simply alert teams when a claim is denied but facilitate insights into why the claim was denied and offer additional measures to save on claim revisions and prevent future rejections.
From filing NOAs to controlling LUPAs, organizations need an optimized RCM to back their people and processes. Accurate, timely documentation will help keep an organization compliant with government regulations, and an effective RCM process ensures this by providing a workflow that is consistent, easy to perform, and trackable.
Optimized RCM doesn’t just improve back-end operations but results in better patient care as well. It helps payors approve an agency’s care and reimburse promptly. This influences patient access to care by eliminating treatment delays due to processing or billing issues.
The key to effective RCM in today’s competitive market lies in establishing a technology-enabled process. Having a digital and automated RCM solution enables post-acute care providers to be proactive about their organizations’ revenue and financial performance. Instead of allowing claims to impact viability, providers can focus on early detection, identify eligibility issues, and prevent initial claim rejection while also ensuring timely reimbursement.
Having this kind of software doesn’t mean healthcare providers need to outsource RCM or settle for a one-off solution that only accounts for key billing processes. Instead, organizations should consider implementing a comprehensive solution that encompasses every element of care coordination, from patient intake to ongoing performance monitoring and every step in between.
These care coordination platforms give administrators and clinicians the tools and processes they need to maintain optimal internal operations and provide the best quality of patient care.
An intuitive care coordination platform saves administrative staff significant time and effort, from initial patient intake to ongoing record-keeping and claims submissions.
With a reliable solutions platform, processes are streamlined to ensure that providers gather thorough, accurate information in one swoop. Healthcare organizations can reduce patient onboarding time by up to 50%, and this faster onboarding speeds patient care initialization, reduces administrative tasks, and simplifies claims filing and management down the line. These efficiencies help healthcare organizations operate more effectively and minimize referral costs — by an average of $60 for every referral that funnels through their pipeline.
As providers evaluate new patients and begin creating treatment plans, the right care coordination platform can support healthy RCM and improve patient care from the first touch.
Equipped with dynamic solutions, care teams spend less time filing paperwork and more time with each patient. This allows them to assess patients’ conditions more thoroughly at the start of care, identify reimbursable conditions and build out detailed care plans based on patient interactions and the robust documentation collected at each interaction. All documentation is aggregated in a single, cloud-based dashboard so care teams can reference accurate, updated patient information throughout the course of care.
Documentation is a primary driver of effective care coordination. As mentioned above, it drives internal processes and enables care teams to provide the most valuable treatments to patients while also ensuring care is recorded, monitored and billed appropriately.
A quality care coordination platform holistically supports a healthy revenue cycle by capturing and processing critical documentation through a central channel. Providers can create, upload, or reference digital documentation through a secure, user-friendly interface that centralizes patient records and ensures compliance with HIPAA and payor regulations.
With precise intake, documentation and care coordination processes in place, final billing and reimbursement workflows will accelerate automatically. Rather than sifting through disorganized data or resolving a growing list of claim rejections, A/R teams can coordinate with internal and external parties more efficiently.
Fewer errors and delays help shorten the average document sent-to-signed cycle and reduce time spent on A/R tasks by up to 60%. As healthcare organizations, payors and providers adjust to evolve with new legal regulations and billing frameworks, a reliable, intuitive billing system within an integrated care coordination platform has grown essential for success.
Healthcare organizations that treat Medicare or privately insured patients provide their services and then receive reimbursements for the care. Forcura’s care coordination platform provides transparency into clinical records and workflows so users can take follow-up actions accordingly. More efficient processes allow final collections on outstanding accounts to begin sooner and yield more profitable results.
At its core, Forcura’s solution helps clients manage care coordination with transformative efficiency, efficacy and ease, with features that set Forcura apart from the competition:
Care teams leverage the platform to meet requirements promptly to receive the full payments they deserve. By partnering with Forcura, they’ll also see process improvements and uncover new efficiencies across various care coordination workflows.
"With visibility into physicians and orders outstanding and the number of orders and documents transmitted out, we can see the ROI and efficiencies from a productivity standpoint with Forcura."
"With Forcura and our increased cash flow, we're in a good place to handle the growth at a decent pace. We can start to do things like adding sign-on bonuses and referral bonuses to grow the business, and we're prepared for changes that come down from Medicare and Medicaid."
Before the COVID-19 pandemic, Visiting Nurse Service of New York (VNSNY) used a well-known content management software vendor for documentation processes and other services and link staff to the organization’s electronic health record (EHR). However, VNSNY had several issues with the software, resulting in documentation inefficiencies and extra work for staff members.
Forcura’s solution introduced an optimized intake process that helps staff verify up to 98% of all physician contact information. Orders management also improved significantly as the ability to track signing physicians led to higher accountability, more effective physician outreach and shorter turnaround times. VNSNY now retrieves physician signatures at a rate of 80% within 30 days instead of the 55-60% they saw with previous software.
The Covid-19 pandemic disrupted operations and forced The Visiting Nurse Association of Greater Philadelphia (VNA Philly) VNA Philly to absorb unexpected costs throughout the year for spikes in personal protective equipment (PPE) purchases, high staff turnover and ongoing training costs associated with new hires.
VNA Philly slashed its orders cycle time by ten days and boosted the efficiency of new-hire onboarding using Forcura’s care coordination platform. Teams can now accurately and efficiently manage their orders, reducing their time from sent-to-signed from 18 to 8 days and effectively removing the issue of orders aging from your revenue management workflows.
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