10 Steps To Optimize Your Revenue Cycle Management

Revenue cycle leaders are facing constant change, staffing shortages, and increased workloads. There’s good news, however — healthcare organizations are finding ways to make low-cost improvements in everything from pre-service processes to post-service collections through revenue cycle optimization. And they are getting results.

“We’ve spent the last five years very focused on optimizing and streamlining many of our practices,” said Becky J. Peters, CRCR, CHAM, Executive Director of Patient Access Services at Banner Health.

At Texas Health, revenue cycle leaders are taking a similar approach. They’re examining daily tasks to save time and money. “We are reevaluating workflows and creating efficiencies,” said Lora Redden, senior director of the Patient Financial Experience.

More technology is not always the best solution

In a recent healthcare provider survey, half of healthcare executives said the revenue cycle is a top priority for software investment in 2023. However, large technology investments aren’t always realistic in the near term when hospitals and health systems are struggling financially.

Some planned revenue cycle software investments aren’t happening right now, but that’s not necessarily a bad thing. “Not all process issues are best served with technology,” said Amber Hermosillo, Revenue Cycle Educator and Quality Director at Banner Health.

Instead, leaders can take a holistic approach. Savings can come from optimizing existing revenue cycle resources. To get maximum benefits, they need to scrutinize every daily task for potential optimization. “From the least complex workflows to the highest complexity workflows, finding a minute here or there can add up quickly,” said Hermosillo.

More efficiency means less staff frustration

Many revenue cycle positions are viewed as entry-level roles. Yet the job increasingly requires more expertise. “If you want to retain staff, you can’t overwhelm your team,” warned Jessica Budri, RN-MSN, CHAM, Director of Patient Access at Connecticut Children’s Medical Center.

Teams are working harder to obtain payment for services rendered. Optimizing processes can help reduce the burnout that leads to turnover. “It is more important than ever to continually look where your teams and your technology can be more efficient,” said Budri.

You can take the following steps to optimize your revenue cycle management process.

1 – Move registration and collections to pre-service

Previously, Banner Health informed patients of out-of-pocket costs on the date of service. “The patients had to deal with that surprise, and how to pay for it,” said Peters. The 15-minute registration process delayed care. Staff now completes all that pre-service. “We are able to fast-track patients on the day of arrival and reduce redundant registration processes,” Peters reported.

At Texas Health, multiple employees made outbound calls to patients about outstanding balances post-service. “Those employees now focus on pre-service estimates and collections,” said Redden.

2 – Cut the time your staff spends logging in and out

At Banner Health, revenue cycle staff signed on to eight software programs. Working with IT and vendors, the patient access team developed a single sign-on. “This improved productivity and staff satisfaction,” said Peters.

3– Streamline your authorization process

A 2023 survey reported that 60% of CFOs and revenue cycle leaders rated authorizations as the most time-consuming revenue cycle task. To rectify this problem, Banner Health improved workflows for validating and submitting authorizations. “This has reduced auth denials and cost to collect,” said Peters. Its imaging center cut authorization denials by 60%.

Revenue cycle staff can’t memorize all payer requirements. “We set rules to filter requests for authorization. The more we do this, the better our workflow and throughput will be,” said Budri.

4 – Review how you utilize administrative support

Many revenue cycle leaders are now traveling less to out-of-state conferences. “We no longer routinely have onsite meetings with vendors and employees,” said Redden. Assistants are freed from travel and catering-related tasks. Redden’s assistant now provides administrative support to several revenue cycle leaders.

5 – Educate clinicians on required documentation

Clinicians sometimes omit important documentation. Missing documentation can cause rework for revenue cycle staff. For example, some payers require radiology imaging and physical therapy to approve an MRI. “If this isn’t documented in the record, it delays the authorization — and therefore, delays patient care,” said Budri.

6 – Reduce hours of rework caused by incorrect information

“For staff, knowing how is not enough. The why is very important,” said Budri. If the scheduling team doesn’t collect accurate insurance, for example, an entire claim can get denied. “A small amount of education on these important points can make all the difference,” said Budri.

7 – Streamline payer notifications of admission

Banner Health’s revenue cycle staff sent faxes 20 to 100 times a day to notify health plans about a patient’s admission. “About 30% of payers require these notifications. The percentage is even higher in our heavier Medicaid markets,” said Hermosillo.

It took two to five minutes for staff to print a face sheet, fax it to the payer, and watch for the confirmed receipt. Certain health plans agreed to accept a daily census instead. The department used existing technology to automatically send the reports, saving hours of time each day.

8 – Identify processes to centralize

Banner Health’s revenue cycle department centralized all pre-service functions for hospital and ambulatory scheduled services. This included prior authorizations, pre-registration, financial counseling, price estimates, and collections.

Centralized teams can cover more sites with the same resources. They also allow staff to work from home and decrease loss of productivity during staff absences. Previously, managers had to find someone to cover shifts or work short-staffed. “Splitting the work now means a few more accounts to work, versus taking on an entire person’s workload,” said Hermosillo.

9 – Find a way to speed up the check-in process

Previously, staff at Banner Health printed out a face sheet and asked the patient to confirm name and date of birth. Now, patients review and initial the armband — which is already preprinted. “This saves time — and also a lot of paper,” said Hermosillo.

10 – Consider outsourcing

Third-party vendors can perform billing and collections, either specific tasks or the entire revenue cycle process. “This can reduce staff workload and improve collections efficiency,” said Andrew Hajde, CMPE, Director of Content and Consulting at MGMA.

Invest in revenue cycle optimization for immediate and future savings

A small amount of effort to identify target areas for improvement can pay off with incremental — and possible exponential — savings over the long term. What areas can your organization optimize that will result in significant future savings? Consider staff education for your revenue cycle team. With greater knowledge and training, your staff can help maximize resources to the fullest.