Reviewing Revenue Cycle Strengths and Weaknesses

Like a car, the revenue cycle is a vehicle we use to get from Point A to Point B. Our main focus may be on reaching Point B, but we know that we can’t take for granted the vehicle we use to get there. We need to perform regular upkeep: on the basic side, we fill the tank with gas and keep air in the tires. Sometimes, however, we need to troubleshoot and run diagnostics to identify problems and know how to solve them. Recognizing revenue cycle strengths and weaknesses is fundamental to maximizing the performance of your healthcare organization.

Know your Past and Present

First, know the numbers. Your practice should be running regular revenue cycle reports to monitor the performance of your organization and identify opportunities for improvement. In addition to financial reports, review other in-house performance data to include metrics on the effectiveness of the organization as a whole as well as the performance of individuals. For example, an unacceptable rate of denied claims may signify a need for more staff training and support. For another example, a staff member who interacts with clients throughout the day may lose productivity with other assignments, and in such a case a restructured role may be beneficial to both the staff member and the organization. Keep organizational design in mind at all times to improve staff training, oversight, and performance in all functions.

Plan for the Future

Your evaluation of the revenue cycle will need to take into account the organization’s plans for the future. Before embarking on a road trip, you need to decide where you want to go and develop a plan for how you want to get there.  Any review of the revenue cycle with the purpose of understanding its strengths and weaknesses needs to be forward-looking, and not just reactionary based on past performance. If you want to succeed at fulfilling goals in the future, spend today anticipating both internal and industry trends, and prepare for shifts in the policy winds. For example, major trends in the last decade have included the Affordable Care Act, ICD-10, and a spike in self-pay patients. Evaluate your current strengths and weaknesses through a lens that anticipates the needs of tomorrow given the information that is available today.

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Use your Resources

Healthcare organizations can use a wide variety of resources to identify their revenue cycle strengths and weaknesses. The more resources you use, the more of an edge you will gain. Is your organization using its IT infrastructure and software to their full capabilities? What points of pain can be addressed through hardware and software? Aside from the technology itself, are you taking full advantage of the associated support? Your revenue cycle management vendor can be an excellent resource for helping you identify strengths and weaknesses. Keep in touch with industry news and professional organizations to learn of trends and best practices. Finally, don’t overlook the low-hanging fruit: good internal communication, training, and feedback between all staff involved in the revenue cycle can identify problems before they show up in reports. Build mechanisms for regular staff communication into the infrastructure of the organization.

It is worth the time it takes to evaluate the strengths and weaknesses of your revenue cycle program as part of overall strategic planning. The better the machine is maintained, the more you can depend on it to get you to your final destination.