Rhonda Barcus, Program Specialist
For the past three years, I had the opportunity to work with the Kansas Department of Health and Environment (KDHE) and Sara Roberts, Director of Kansas Office of Primary Care and Rural Health and more recently with Jennifer Findley from Kansas Hospital Association on a Revenue Cycle Management (RCM) project. We supported 19 hospitals in Kansas with technical assistance to assess their current practices and benchmark those against best practices in RCM.
For all the 13 hospitals participating in years one and two, I had the opportunity to talk with their leadership teams at six and nine months about their progress of implementing the best practice recommendations. The progress and outcomes for most of them were astonishing! What really stood out to me were the common themes from the most successful projects. I wanted to share the top three themes with you.
Revenue Cycle Management (RCM) involves the process of patient charge capture from beginning to end, from creation to payment. It includes a number of steps that begins with patient registration and continues through the delivery of care to billing and to eventual payment. It is a process that involves a number of hospital departments: business office, clinical providers, registration, utilization review and coding to name a few. Because of its complexity and the number of staff that “touch” this process and the reliance on detailed, specific and accurate information at each step, hospitals may find that small errors can result in big financial losses, wasted staff time and decreased staff morale. A well-run RCM impacts patient satisfaction while a fragmented process results in frustration and patient dis-satisfaction.
The first step that every team took was to create a revenue cycle team. The team included business office folks, yes, but also included staff from clinical areas, registration, health information management (HIM) and information technology (IT). This team met weekly. Every leader said the success of this project was dependent on frequent meetings so that RCM issues could be addressed quickly and as close to real time as possible. The team looked at any issue or problem involving RCM over the last week and took immediate steps to remedy it. This kept them focused and they were all aware of the need for constant and consistent attention to make steady progress.
A second factor in their success was the focus on pre-registration. Patient information, coverage for upcoming procedures, co-pays and deductibles were all identified prior to a patient coming for their scheduled procedure when possible. Checks and balances were put in place to ensure accurate collection of information since one small error could impact the success of the entire revenue process. Staff were included in discussions about this so that they were very aware how they affected the success of the process.
A final theme, and was the hardest for many hospitals, was requesting payment from the patient! The hospitals were very transparent with the patient prior to coming for services about their financial responsibility at the time of service. Great care was taken to make sure all staff involved had the right education, training and re-education to do this effectively and with sensitivity. The hospitals also talked openly with patients about needing to pay prior balances and some future scheduled procedures were contingent on something being paid on previous balances. More than one hospital noted that this is part of their culture now and the community and patients just accept it. One CEO noted that almost all patients now come prepared with some type of payment. They noted that while many hospitals fear losing patients if they take this step, when done with sensitivity and skill by staff, that fear has been unfounded.
In addition to the common themes in implementation of best practices, all the hospitals were able to identify measurable outcomes. These outcomes included a decrease in accounts receivable, decrease in claim rejection, and an increase in collections. Also significant were the “non-measurable” outcomes. The hospitals all reported that there was better teamwork within and among departments, staff pride in the success of their work and more accountability across the organization!
The National Rural Health Resource Center (The Center) is a nonprofit organization dedicated to sustaining and improving health care in rural communities. Rural Health Innovations, LLC is a subsidiary of the National Rural Health Resource Center.