Disparate Revenue Cycle Management (RCM) technologies and service partners lead to inefficiencies and increased error potential. However, according to a 2018 survey by Dimensional Insight and HIMSS Analytics, two-thirds of healthcare organizations use multiple RCM technologies. Why? Because until recently, it was the only choice. Today, innovative revenue cycle solutions integrate critical RCM coding, billing, reporting, and practice management functions. As a result, healthcare organizations are empowered to consolidate siloed RCM vendors. By working with one partner or synthesizing the data from a few partners, organizations can reduce denials, increase efficiency, boost revenue integrity, and reduce data collection challenges. With all relevant data centralized, opportunities to improve RCM performance, ROI, and efficiency abound.
As healthcare becomes increasingly competitive and consumer-focused, understanding, optimizing, and improving revenue cycle performance is paramount to remaining competitive and meeting consumer demand. Consolidating data inputs is a first step toward meaningful understanding and strategic action.
In this post, we explore why addressing RCM data integration is important and how to approach it within your organization.
The Movement Toward Unified Data
If you currently juggle a maze of siloed systems and vendors to manage revenue cycle operations, you are not alone. Some healthcare organizations rely on 6 or more technology vendors and RCM service providers. Very few have a single-source of RCM-data truth. However, the industry’s movement toward value-based care is driving an increased focus on data management. Today, the goal is to achieve a sole source of real-time information for analysis and decision-making across the entire revenue cycle process.
As we harness the enormous amounts of data available to us from disparate sources into a unified database, we unlock a new frontier of smarter insights that will drive better care quality and more accurate and efficient revenue predictions. In the revenue cycle management realm, creating a unified RCM database allows us to learn from end-to-end claims processing visibility and greatly decreases the amount of time we spend making actionable sense of data.
Overall, the movement toward unified data grants us access to holistic information that can help us optimize workflow processes, streamline billing and collection cycles, track payment trends, ensure compliance, and improve denial resolution.
The Value of Reducing Data Fragmentation
Centralized data in one common platform can help reduce the time and cost required to handle every aspect of RCM—from claim submission to patient engagement. When data from EHRs, PMs, billing, and reporting systems is in one place that can be viewed by all stakeholders in real-time, patients, revenue, and organizational efficiency alike benefit. For example, when we have visibility into a single record that tracks a patient’s entire journey from their first clinical encounter to their final payment, care coordination and billing workflow can improve. In summary, more data in one place has the power to accelerate the revenue cycle and optimize patient care.
Benefits of data and system unification in your RCM process include:
Increased Efficiency and Productivity: There is no function of revenue cycle that cannot benefit from data unification. Each process, from billing and coding to revenue reimbursement and claims processing can be managed more efficiently with streamlined data, less programs, and automation of mundane activities. For example, unified data and systems equates to less reliance on manual data entry and less duplicated efforts across systems. Unified data also highlights clear opportunities for targeted staff training and process optimization.
Reduced Errors: RCM errors are extremely costly to healthcare organizations. For example, patient identification errors can cost up to $2,000 per patient, and are associated with a third of denied claims, costing the average hospital $1.5 million each year, according to a survey from Black Book. By working with fewer systems, the number of times your staff is required to context switch decreases\, thus reducing avoidable errors and duplicate records.
Smoother Patient Experience: Consolidated data and systems mean a smoother end-to-end process for patients. Increasingly, patients expect a frictionless, transparent healthcare billing experience; unified data helps meet that expectation. When the right system or select few systems integrate seamlessly, we are better equipped to offer a convenient and personalized patient billing experience that leads to more satisfied patients overall.
Less Claim Denials: A well-calibrated claims review platform that leverages data from multiple inputs can improve claim completeness and accuracy. Technology can proactively prevent and fix a potential denied claim before claim submission. Additionally, unified data and systems can analyze claim denials overall and flag common reasons claims are rejected to prevent the same issue in the future.
Shorten Billing and Collection Cycles: Managing siloed systems with differing interfaces, data types, methodologies, and touchpoints is complex and time consuming. Fewer systems and unified data mean more transparent visibility into opportunities to optimize collection times and improve billing efficiencies.
How to Streamline your RCM Data and Systems
True “all-in-one” RCM solutions are still unicorns in the industry, particularly as the footprint of your group expands. It is challenging to find one system that delivers all the service and technology functionality that you will need. In fact, you may not want just one vendor. It may be prudent to have redundancy and competition in your RCM service portfolio. Every healthcare organization—from large management service organizations to independent providers and provider groups—have nuanced RCM requirements. However, regardless of your requirements, it is possible to find a partner who can unify the data from all your systems.
If you cannot find just one solution, we suggest selecting a core RCM solution that meets the highest number of your needs to optimize workflow and streamline reimbursement. Ideally this partner offers a suite of services and technology that work seamlessly together and unify all relevant data in one hub. Your core partner should also be committed to data transparency and continually innovating and evolving with you as your organization grows.
Here are a few questions related to unified data we suggest asking your RCM partner:
- Is your system easy for my staff to use?
- Can your system scale up or down easily as we acquire new business?
- Can you integrate data inputs from multiple into a single data hub?
- How do you leverage data to spot the root cause of denials?
- How do you automate collection processes?
- Do you offer real-time reporting and full data transparency?
- How have you helped your partners streamline workflows to reduce time spent on mundane or avoidable tasks?
- How can we create a frictionless RCM process for both our providers and patients?
- How can we ensure accurate patient identification from registration to billing?
If your current or prospective partner has strong answers to these questions, they are a strong core partner to help you optimize your revenue cycle and reduce data fragmentation.
Power Data Integration and Performance with an All-in-One RCM Technology and Service Solution
An ideal partner will not only manage your revenue cycle, but also assess your technologies, integrate your data, offer actionable insights based on that data, and implement processes to improve operational efficiency. You can offload non-clinical tasks, save money, reduce errors, and prevent claim denials with an RCM partner with powerful data and technology tools. Resolv, a Harris Revenue Cycle Business can help. Learn more about how Resolv’s 25+ years of emergency medicine revenue cycle management experience, innovative technology, and dedication to patient engagement can help your group streamline siloed RCM functions and harness actionable data. Book your free consultation with Resolv today.
About the Author
Alex Collevecchio, Portfolio Manager, Resolv Healthcare
As the Portfolio Manager of Resolv Healthcare, Alex manages the growth of the Revenue Cycle Solutions portfolio of businesses: First Pacific Corp, Innovative Healthcare Systems, and Innovative Medical Management, each serving a different revenue cycle market. Alex is a former Partner at Infosys Consulting and IBM GBS. He has also been the innovative and operations CEO, strategic growth, and digital transformational leader of three North American Business and Technology Consulting Services and Software / SaaS companies for his French and German parent companies (e.g., Alti – Founder). Alex has led his customers and employers through business and technology enterprise applications modernizations through digital innovations strategies and transformations. His focus is on software and services for healthcare and life sciences sectors.