The Elephant in Your RCM Room

Shhhhhh….There are things we just don’t talk about when it comes to Revenue Cycle Management.  It’s ok to talk about collection rates, days in AR, aged balances and denial rates because we’re all on the same page here in terms of performance benchmarks and the process improvement activities we’re undertaking to address performance.  But what we don’t talk about… the proverbial elephant in the room… is revenue leakage, i.e., charges that were never captured or got lost along the way and therefore never get billed.

If we visualize the Mid Revenue Cycle simplistically as a funnel with patients entering the revenue cycle at the top of the funnel, care being delivered, documented and coded with revenues exiting the bottom, the goal for Revenue Integrity professionals would be to get as close to 100% of the revenue their organization is entitled to receive in the shortest time possible.  In physics, this is referred to as the volumetric flow rate which follows the basic formula Output = Volume/Time.  If your goal is to optimize mid-cycle revenue, you then have two levers to pull…

  1. Make the flow “frictionless” by re-engineering and streamlining processes, AND
  2. Add more volume by eliminating waste in the form of Mid Revenue Cycle leakage (i.e., missed, miscoded or misplaced patient charges that leach out of the funnel).

I’ve emphasized the word “AND” because both volume and efficiency are critical factors in optimizing revenue.  Today, very few healthcare organizations are addressing the volume issue for two primary reasons…

  1. They lack the tools or analytics to measure and monitor leakage
  2. They view leakage to be a performance deficiency instead of an opportunity.

The reality is that leakage occurs in every hospital or physician practice – HFMA has estimated that 3-5% of all charges never get posted – and very little of it is related to human error.  Leakage often results from technology gaps, ill-advised or obsolete billing practices, or upstream process problems that are systematically causing leakage that can easily be re-engineered once the problem is identified, quantified, and analyzed for root causes.

This is why Revenue Assurance Programs are growing in importance.  Whereas revenue cycle management (RCM) solutions focus on streamlining operational processes surrounding known charges, revenue assurance concentrates on the identification of omitted charges that never make their way into your revenue cycle queue or have leached out of your revenue funnel. There are very few companies that focus exclusively on revenue assurance. An even smaller number combine a technology solution with a service component that intervenes to reduce false positive findings while also providing analysis that creates a dialog about codifying best practices. Applying rules-based and predictive analytics to the complex world of medical coding and billing simplifies and automates the labor-intensive process of manual chart reviews. It also yields consistently objective findings to break down silos in healthcare organizations by comparing data from different departments to ensure consistency and identify communication breakdowns.

 “Smart Investment”

Healthcare provider organizations have been compelled in recent years to make “strategic investments” in projects that have strategic importance regardless of the cost or required effort with no direct ROI often because there is an inherent risk if you don’t do it.  Enterprise Resource Planning (ERP) and Electronic Medical Record systems (EMR) fit that description.  And then there are opportunities to place bets on investments big or small because they’re the smart thing to do financially – what we term “value investments”.  We now use Bubble Charts to analyze the various projects in a portfolio to visualize the balance between the value or profitability vs. the size of the required investment vs. the perceived risks involved… namely, how likely is it that we’ll achieve the expected returns, what are the risks of a runaway project that turns out costing 2 – 3 x what we budgeted, and what is the timeline of the project and when do we expect to recognize a return on our upfront investments.

Initiating a Revenue Assurance Program is one of those Smart “Value” investments because of the low barriers to entry, short time-to-value (as little as 60 days), high probability for success and significant financial returns with extremely low operating costs.  The best part of the decision, is that you can now address the elephant in the room and begin measuring and managing your revenue leakage.

About AcuStream

AcuStream is a Revenue Assurance specialty company dedicated to the healthcare industry. AcuStream provides automated charge capture auditing technology solutions, value-add professional coding expertise, and decision support tools to the country’s leading healthcare providers enabling our clients to find missed revenue around charges they didn’t know were missing. We are the only organization with proprietary algorithms and custom client specific rules, that can correlate both the hospital data and physician data. This in conjunction with our world class workflow, allows us to find and track missed, miscoded, and misplaced charges.

AcuStream identifies and quantifies missed reimbursable charges for both Physician Organizations and Health Systems. REVBUILDER™’s automated post-bill auditing solution identifies omitted charges while REVREVIEW™ auditors validate charges against your own EMR documentation and payer contracts to ensure you get paid for the services provided.

AcuStream has been privileged to work with one-third of the academic medical centers on the U.S. News and World Report “Honor Roll of Best Hospitals,” seven of the 50 largest integrated health systems, twenty percent of the 20 largest not-for-profit health systems, and 10 of the nation’s largest physician group practices providing immediate financial lift/profitability, management insights and process improvements surrounding Revenue Management.Acustream currently processes over 100,000 doctor’s data on a monthly basis, thanks to our client base of top hospitals and physician organizations in the US. The result of our solution is improved net profit, decreased revenue erosion, and a clear view into departmental efficiencies.

We help you identify the missing pieces to your revenue puzzle, BEFORE you even start to put the puzzle together.

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