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The Revenue Cycle Revolution – Are You Ready?

Publish Date
Read Time
June 21, 2019

The healthcare landscape becomes more complex by the day. Value-based care. Regulatory requirements. Systems integration. Resource constraints. Payer payment tactics. All of these items, in addition to maintaining efficient daily operations, create challenges for the revenue cycle. Clinical and financial resources, processes, and technology have typically been siloed, but in today’s environment, it is critical to bring these two workstreams together in a “Clinically Integrated Revenue Cycle.”

When a patient begins their healthcare journey, clinical and financial pathways alike are opened up, and their relationship is far more interwoven than the current operating model reflects. The Clinically Integrated Revenue Cycle will allow organizations to move forward and tackle the hurdles they are facing by leveraging data combined with powerful analytics to navigate the landscape that is on the horizon.

The Electronic Health Record (EHR) and the advancements associated with systems that populate the patient record has caused unprecedented changes in the way that organizations run their revenue cycle. Because of the changes, organizations are realizing the importance of acquiring and refining processes and securing external partners to address fundamental items within the revenue cycle.

Lay the Foundation for a Clinically Integrated Revenue Cycle

Organizations must keep in mind that at the foundation of everything they do, “every record represents a real person.” In order to provide the best care and receive proper reimbursement, the medical record must serve as the source of truth for organizations. It must reflect the True Clinical Picture. Clinical documentation continues to become more and more complicated, driven by multiple data elements, systems, users, patients, and varied payer requirements, all of which can lead to complex problems for the revenue cycle. Ensuring the accurate capture of the clinical care provided is the first step in a Clinically Integrated Revenue Cycle.

The Clinically Integrated Revenue Cycle will change health information management and revenue cycle roles. Increased collaboration is needed to adapt and adopt new processes that capitalize on technology in what will be an increasingly data-driven revenue cycle. The revenue cycle of the future requires master navigation of the clinical documentation and supporting processes that accurately define and document the care of the patient. Likewise, clinicians must understand the downstream effects of the documentation on reimbursement to ensure the patient’s care is accurately reflected in the medical record.

As the challenges to the revenue cycle increase, healthcare organizations are increasingly outsourcing revenue cycle functions. It’s critical to approach outsourcing not as “vendor management” but rather as a “partnership” that can strengthen processes and build a revenue cycle that is more efficient, effective, and ultimately financially stable.

Preparing for the Revenue Cycle Revolution

Organizations must utilize multiple strategies and processes to achieving this next-generation revenue cycle. Traditional functions and processes must be reexamined in order to secure a solid foundation for the future and you can start by:

  • Raising awareness of what a Clinically Integrated Revenue Cycle is – and doing this across the organization so each player understands their role in the financial health of the organization
  • Completing a revenue cycle assessment to identify organizational revenue cycle challenges that are impacting the bottom line, in addition to identifying areas of risk.
  • Reviewing core technologies and third-party systems to determine if they can support the integrated approach to revenue cycle management.
  • Modernizing your CDI programs and conducting ongoing coding quality audits to ensure accurate documentation and billing to reduce the potential for claims rejection.
  • Analyzing your current denials data to develop a proactive strategy for preventing and managing denials.
  • Partnering with a third-party revenue cycle expert to “fast track” your opportunities and readiness for implementing a Clinically Integrated Revenue Cycle.

Navigating the changes that are having an impact on revenue and reimbursement requires us to understand the inter-related parts that make up the revenue cycle, with an eye on both upstream and downstream activities. The Clinically Integrated Revenue Cycle ensures that people, processes, and technology are aligned to ensure the financial health of the organization, without losing sight of the true mission of all healthcare providers – delivering the highest quality of care to patients.

Learn more about Creating a Clinancial Model.

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