Understanding the Claims Lifecycle: A Step-by-Step Guide
Grasping the details of the claims lifecycle in healthcare is crucial for getting timely reimbursements and maintaining financial well-being. As...
Picture this: you’re juggling multiple RCM vendors, each claiming to be the best at their part of the puzzle. But instead of fitting together seamlessly, they create a complex web of processes that stretch your resources thin. So, how do you know when you’ve hit the tipping point with too many vendors?
Here are key signs that indicate your RCM team might be overwhelmed – and what you can do to alleviate that burden:
Sign #1
Data Silos
Leaders often face difficulty efficiently tracking performance due to the existence of data silos. The RCM landscape is highly fragmented with data spread across various systems, making it challenging to monitor overall performance effectively. An increasing need for data consolidation via a unified platform is evident.
How to Fix: Consolidate with an RCM platform. Streamline your technology by adopting a unified platform that integrates all aspects of your RCM. This helps ensure data flows seamlessly, providing a complete picture and reducing the risk of disparate information. With 66% of revenue cycle leaders planning to invest in such platforms, it’s a strategic move toward clarity and efficiency that many of your peers are already exploring.
When evaluating an end-to-end revenue management platform, it’s important to look for a technology that offers frictionless delivery, platform integration and performance tracking throughout all stages of the revenue cycle. This adds context across the entire continuum, fostering more predictive and proactive revenue management.
Sign #2
High Denial Rates
It’s no secret that high denial rates are a well-known challenge. These not only threaten your financial performance, but also signal the need to streamline your RCM vendors for improved efficiency.
A survey conducted by HIMSS and Dimensional Insight highlighted the challenges faced by health systems using multiple vendors for RCM. More than two-thirds, or approximately 70%, of health systems employ more than one vendor, and they report larger issues with denials compared to those using a single solution. Specifically, nearly 70% of health systems with three or more vendor solutions identify denials as their primary challenge.
How to Fix: Assess your current tech stack and develop a strategic roadmap for addressing denials with the right tech approach. The Revenue Cycle Management Technology Adoption Model (RCMTAM) draws from over 30,000 data points and delivers benchmarking insights from healthcare finance leaders.
The model offers personalized analysis to enhance financial performance and efficiency, linking technologies with business processes. By identifying under-optimized areas, it drives focus on investments and promotes best practices ultimately aiding in effective denial management.
RELATED: Get Started on Your Complimentary RCM Tech Assessment
Sign #3
Workforce Inefficiency
When your team spends excessive time navigating different platforms instead of focusing on patient care, it’s a sign that screams of inefficiency. For example, if staff are constantly shifting between systems to input or retrieve data, productivity takes a hit.
How to Fix: Invest in workforce training. Equip your team with the skills necessary to thrive in a single-platform RCM environment. A big key for success is finding a vendor partner with these training offerings:
- Training early in onboarding and involvement through go-live and beyond
- Scheduled sessions after go-live to answer specific questions and address issues
- Ongoing training sessions as your experience grows to maximize ROI
Plus, training empowers staff to focus more on patient care rather than juggling multiple systems, boosting overall efficiency.
RELATED: 3 Ways Improving RCM Can Combat Staffing Shortages
Multiple point solutions may seem like an affordable way to automate each step of the revenue cycle process. Unfortunately, redundancies, manual steps and integration mishaps can make a suite of disparate technologies ineffective. Having a strategic view of the complete revenue cycle—along with a singular tech solution that spans the cycle’s entirety—ensures a seamless process from patient to payment, helping to streamline workflows and generate a positive ROI.
Switching to a singular RCM platform isn’t just about technology—it’s about strategy and innovation. By consolidating vendors and adopting a single-platform approach, healthcare organizations can unlock new efficiencies, boost patient care and achieve sustainable growth, turning the RCM process from a tangled web into a streamlined success story.
