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By AGS Health
July 11, 2023
There is no end in sight to the chronic coding and revenue cycle management (RCM) staffing shortage that has healthcare organizations looking for new ways to keep revenue flowing with too few qualified professionals to handle critical processes.
As we discussed in a recent HIT Consultant article, A Hybrid, Technology-Driven Approach to Overcome Coding and RCM Staff Shortages, the worsening shortage and its short- and long-term impacts have moved staffing to the top of priority lists for many health information management (HIM) directors, revenue cycle leaders, and CFOs – leaders who are already dealing with the extreme financial pressure as well as greater regulatory uncertainty and audit scrutiny. Many are also realizing that the smart strategy to address these woes is one that focuses on optimizing the productivity of existing teams by adopting a hybrid approach that augments internal teams with outsourced coders and a substantial focus on automation wherever possible.
Not only can this approach reduce existing backlogs and avoid employee burnout, but it will also drive improved revenues through increased collections, reduced delays and denials, and fewer days in accounts receivable. This is because outsourced partners are in a better position to identify problems in coding that contribute to higher denials rates and offer solutions to resolve them before they impact the revenue cycle – not to mention access to scalable resources to meet patient volumes, support workloads, remove bottlenecks, and enable internal staff to focus on value-added tasks.
Key to a successful hybrid approach to overcoming staffing challenges is adding the right technology to the mix. Specifically, artificial intelligence (AI) and automation can improve speed and accuracy and optimize processes while freeing internal resources to focus on core coding and RCM responsibilities. Low-skill, repetitive tasks that don't require critical thinking skills are prime for automation. Meanwhile, AI can support back-end RCM processes like claims scrubbing, identifying patient self-pay amounts, and alerting patients to amounts due and electronic collections.
Additionally, comprehensive data analytics software can deliver visibility into crucial organizational metrics, while automation can reduce the need for review and query management and eliminate the need for spreadsheets. Further, advanced computer-assisted coding (CAC) now leverages AI to accelerate coding decisions, and CAC compliance software integrates with RCM workflows to automate auditing tasks.
There are several best practices that healthcare organizations should follow when it comes to outsourcing and technology to ensure they identify the right partner. Among the attributes to look for are the vendor’s depth and breadth of experience. This will also highlight their ability to grasp the complexity of federal and state regulations. Other attributes include:
Ask how many charts on average they are capable of coding per day, week, or month and about their HIPAA compliance policies and procedures. Finally, it is important to speak with referrals who can candidly discuss the prospective partner’s ability to deliver on the promises made during the sales process.
It is also important, once the partner is identified, to establish key performance indices (KPIs) to monitor outcomes. These could include traditional metrics like collecting costs and days in A/R as well as non-traditional A/R metrics such as cash as a percentage of net revenue. The right KPIs help ensure a transparency-based relationship based with clearly defined and measurable goals.
The key to striking the right balance of technology and service is to take the time to understand the organization’s unique staffing challenges and identify the right mix of services and solutions to overcome them.
Look for a partner that will take the time to analyze existing processes to determine the areas ripe for improvement. This should include assessing existing people, processes, and technology to create a custom solution of services, technology, and support, amplifying what works while addressing what doesn’t.
Finally, recognize that revenue cycle management is not static. As such, any outsourced partner must be willing to pivot to adjust services and provide scalability to meet changing needs.
To learn more about adopting a hybrid RCM model to address labor shortages, check out our white paper, “A Hybrid Approach to Overcoming Coding, RCM Staff Shortages.”
AGS Health is more than a revenue cycle management company–we’re a strategic partner for growth. By blending technologies, services, and expert support, AGS Health partners with leading healthcare organizations across the US to deliver tailored solutions that solve the unique needs and challenges of each provider’s revenue cycle operations. The company leverages the latest advancements in automation, process excellence, security, and problem-solving through the use of technology and analytics–all made possible with college-educated, trained RCM experts. AGS Health employs more than 10,000 team members globally and partners with more than 100 clients across a variety of care settings, specialties, and billing systems.