Will COVID-19 Have a Lasting Effect on RCM Workflows?

Will COVID-19 Have a Lasting Effect on RCM Workflows?

Some practices are re-thinking their RCM workflows and suppliers after COVID-19 exposed challenges with system integrations and operational requirements.

Originally published on RevCycle Intelligence – COVID-19 fundamentally changed the business of healthcare, prompting some practices to rethink RCM workflow and vendor strategy.

Billing departments that normally worked under the same roof suddenly went virtual. Drops in claims volume led to layoffs and furloughs. Delayed payments and declines in revenue had the genuine possibility of closing the doors of many healthcare organizations.

Now that we are entering the ‘new normal,’ many RCM executives are looking back at the last 18 months to find ways to protect their organizations from financial turmoil should another health emergency or unforeseen disruption strike.

Pinpointing inefficiencies

RCM workflow inefficiencies are a well-known contributor to the already complicated claims cycle process. A survey published in JAMA found that administrative complexity is the largest segment of wasteful healthcare spending, totaling an estimated $256.6 billion per year.

“The cost of hiring a professional auditing firm to find inefficiencies may be out of reach for many organizations, especially those that have been hit hardest by COVID,” said Vipul Bansal, CEO and Group President of Medusind. “One of the easiest ways to identify inefficiencies is to examine situations where workflows are adjusted to accommodate systems that don’t integrate. Often, manual intervention is needed to move information from one system to another, which increases labor, adds days to accounts receivable, and runs the risk of data loss.”

survey conducted by HIMSS Analytics found that almost 70 percent of healthcare organizations used more than one vendor for RCM. An overwhelming majority of respondents said that collecting data from disparate systems was challenging; survey results found that respondents with two or more RCM systems had more denials than those using one.

“Organizations have many reasons for using their EHR vendor’s RCM solution. Facility acquisition can carry forward legacy technology and workflows. Choosing to utilize an EHR vendor’s RCM solution, in many cases, is the path of least resistance or a way to provide familiarity with something new. But, this can come at the cost of having high-performance RCM specialization,” said Bansal.

“However, technology advances have made transitioning to a fully integrated, EHR agnostic RCM solution cheaper and easier than ever before. In addition to achieving an overall lower cost-to-collect, best-of-breed clinical and RCM system deployments have the power to accelerate revenue while decreasing payment obstacles such as denials as well as increasing performance and data transparency.”

Evaluating RCM workflows and results post-COVID

According to Bansal, RCM challenges that emerged during the PHE, or existing issues exacerbated by COVID working conditions, may be due to a lack of specialization in outsourced solutions. Common red flags that indicate possible system or vendor specialization shortcomings include:

Weak, or outright lack of, reporting

A common source of frustration and friction with unspecialized RCM solutions centers around revenue cycle reporting. PM software, whether integrated with its EHR twin or not, is able to provide the basics but generally lacks the more sophisticated reporting, analytics, and dashboarding insights that enable healthcare C-suites to make decisions about their growth and utilization strategies. Additional fees for reporting and dashboarding products should not be necessary with the right RCM partner.

Slow payments

Speed to cash is crucial for healthcare organizations to operate on the margins to which they are accustomed. Claims that unnecessarily sit idle can be caused by a lack of software capability or by outdated revenue cycle processes. Slow payments are universally a red flag to RCM executives but should especially be cause for concern if there is a protracted delay for new claims to make progress through the revenue cycle.

The value of an integrated RCM system after COVID

Bansal shared, “The RCM process didn’t change because of COVID. In many instances, lack of system integration led to disruptions in information flow, leading to lower RCM performance. A fully-integrated, EMR-agnostic RCM system, one that can attach itself to your EHR to optimize the flow of information, is the best choice to ensure a stable revenue stream.”

Most integrated RCM systems are now cloud-based, lowering overhead costs by mitigating the need to purchase, install, and maintain expensive equipment. Bansal recommends, “Rather than installing RCM solutions piecemeal to solve problems as you go, we advocate finding an RCM partner with an established record of successful integration with your EHR system. Improving RCM performance now will protect your revenue if unforeseen circumstances occur in the future.”