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Implementing a Revenue Cycle Maturity Framework: Best Practices

By Thomas Thatapudi & Matthew Bridge

October 3, 2023

Implementing a revenue cycle management (RCM) maturity framework that seeks to enhance service delivery capabilities, leverage technology and interoperability, and maximize analytics can significantly improve the financial performance and operational efficiency of healthcare organizations. This final article in our series highlights an example of an organization that has successfully implemented the AGS Health revenue cycle maturity framework to move from the emerging and foundational stages to the more advanced and high-performing end of the spectrum. We also share best practices that can help ensure healthcare organizations continuously enhance revenue cycle operations and achieve their long-term goals.

A not-for-profit health system with more than 40 hospitals and over 350 health and urgent care centers in the southeastern United States faced challenges, including increasing accounts receivable (A/R) days and declining cash collections, primarily due to a 10% to 15% increase in denials post-COVID-19. Low dollar A/R of less than $3,000 were particularly challenging to manage. The organization lacked insights into key performance indicators (KPIs) due to limited automation and a high reliance on manual intervention.

Over an 18-to-24-month period, the organization made significant investments to improve its maturity level. In the area of service delivery, they transitioned from the emerging stage relying on a staff augmentation approach to becoming high performing through global partnerships, centralization, and a focus on complementary offshore partnerships that are leveraged strategically to limit reliance on in-house staff. The results included an increased return on investment while effectively managing overall low-dollar A/R for both professional billing and hospital billing.

Technology and interoperability were in the emerging stage, with minimal integration between the EMR/PM systems and other RCM technologies and limited automation of core processes. A gradual move toward automation now has them operating in the advanced stage with API-integrated real-time claim status and integrated infrastructure, exception-based processing, and computer-assisted coding (CAC).

With analytics, while initially relying on ad hoc Excel-based operations that had them functioning in the emerging stage, the system implemented Microsoft Power BI to gain insights into revenue cycle operations and benchmark their analytics and results against peers, moving them to the advanced stage for analytics with system-wide metric definition and adoption, minimal data integrity issues, and strong visibility into outsourced populations.

By implementing key best practices, healthcare organizations can most effectively leverage the RCM maturity framework. These include:

  • Assess the organization's current maturity level across the revenue cycle to establish a baseline for improvement.
  • Set realistic goals (3 to 5 years) based on the organization's capacity, constraints, and maturity level.
  • Establish iterative, annual goals aligned with a long-term target to ensure meaningful progress and track performance.
  • Cultivate an alliance partner ecosystem that engages with service and technology vendors to access best-in-class resources, leveraging industry forums for broader insights.
  • Conduct regular annual reviews to evaluate progress against goals set in previous steps, adjusting long-term targets as needed.
RCM maturity framework

Implementing an RCM maturity framework based on a comprehensive view of operations that assesses in-house resources, outsourced services, advanced technologies, and actionable analytics provides a strategic approach for healthcare organizations to enhance their financial performance and operational efficiency. Organizations can follow best practices to set realistic goals to improve their maturity levels over time, leverage alliances, and achieve continuous growth in revenue cycle operations.

A Four Stage Journey Toward RCM Transformation and Maturity

View our webinar, “A Four-Stage Journey Toward RCM Transformation and Maturity” and contact us to learn more and discuss how we can help you move through the revenue cycle maturity framework and become a high-performing healthcare organization.

Thomas Thatapudi B&W

Thomas Thatapudi

Author

As AGS Health’s Chief Information Officer, Thomas leads the development of world-class products with unbeatable customer experience through data, digital, and cloud transformation. He brings an exceptional track record of elevating customer, employee, and stakeholder experiences through advanced technologies and technology-enabled services. Thomas is passionate about using data, insight discovery, and digital platforms to build and deploy products, platforms, and services for real and lasting transformation.

Matthew Bridge

Matthew Bridge

Author