Align People, Process, and Technology for Successful RCM

Understand how PPT impacts the revenue cycle

The revenue cycle incorporates a series of steps including scheduling, documenting care, and collecting final, accurate payment. Medical practices must optimize the healthcare revenue cycle process if they want to capture all the money they earn.

Specific aspects of the revenue cycle process in healthcare may change over time. The goals remain the same—an accurate, complete medical record, timely and accurate billing, and patient satisfaction.

Healthcare revenue cycle management can be divided into three phases: front end, mid, and back end. The front end includes registration, patient access, and financial clearance. The mid cycle includes clinical documentation and charge capture. The back end includes claims, billing, and payment.

Next, let’s further define PPT—short for people, process, and technology—to better understand how it impacts revenue cycle balance and outcomes:

• People – talent, skill sets, employee engagement, culture, executive sponsorship, change management, collaboration, and organizational structure
• Process – workflows, policies, governance, measuring, communication, and practice principles
• Technology – health IT platform, software, accessibility, optimization, tools, and utilization

Target specific phases in the revenue cycle

To align PPT, target specific areas based on the phase of the revenue cycle process in healthcare. For example, in the front-end phase, scheduling is an area of vulnerability; front desk staff may capture incorrect demographics or insurance information . An error can have significant ripple effects downstream. The further down the cycle an error travels, the more costly revenue recovery becomes.

How can your practice align PPT with regard to scheduling? As part of your front-office processes, leverage a scheduling template that interfaces with eligibility verification and patient engagement tools to automatically capture required registration data elements. Train your staff on how these tools work together. Taking these steps promotes clean claims and first-time payment and helps create a positive first impression on the patient.

Create balance within your organization

Not uncommonly, a medical practice implements a technology upgrade with new fancy features. Later on, they discover the staff does not use much of the functionality. Why?

The implementation creates an imbalance because the people and process are not aligned with the technology. An application is only as effective as the process established to support it and training provided for the people who must use it.

Aligning PPT creates balance within your organization. Establish effective healthcare technology management processes and put them in writing. Make sure technology implementation projects have executive buy-in. Integrate human resources with the right skill sets. It is the combination of PPT that enables effective use of technology and staff to achieve a shared goal.

Implement a PPT-driven evaluation

Keep it simple and begin with a review of current processes, identify what’s working and not working, determine which problem to solve first, and then create goals. Focus on one phase and area within the revenue cycle.

Encourage a culture of asking questions. This helps to ensure people responsible for a project understand the problem and goals well enough to articulate them. Asking questions also helps bring to light processes that remain in place only because of precedent. Seek out these areas as they are often ripe for improvement.

Measure, audit, and monitor performance to ensure alignment and balance remains intact. Measuring performance is key to achieving optimal revenue cycle outcomes. Examples of performance measures in healthcare that apply to scheduling might include:

• the no-show rate
• the average speed of call answer
• the next available appointment or third next available
• the percent inbound call abandonment rate
• point of service collections as percent of net revenue
• registration accuracy
• the percentage of claims on hold for eligibility and insurance issues

NextGen Enterprise PM and NextGen Financial and Operational Analytics both have reporting capabilities for these healthcare performance measures as well as many others.

Summing it up

Balancing PPT and optimizing the relationships between them is essential for medical practices. The revenue cycle process in healthcare requires constant attention, alignment, and optimization. By targeting specific areas, measuring performance, and leveraging technology, you can optimize your practice’s revenue cycle and ensure accurate and timely payments.