Healthcare in the United States is changing. Mergers and acquisitions have become common for organizations looking to improve their operations and financial standing. A key element of these efforts is the revenue cycle, which includes all administrative and clinical functions that help capture, manage, and collect patient revenue. The old view of revenue cycle management (RCM) as just billing and collections is no longer valid. It is now seen as a system that affects cost management, compliance with regulations, patient experience, and financial performance.
Mergers allow healthcare organizations to change their RCM processes. They create chances to optimize existing systems, consolidate resources, and adopt new technologies. By aligning revenue cycle operations with strategic goals, organizations can make the most of their technology investments, improve efficiency, and enhance the patient financial experience. Solutions like Simbo AI are helping automate front-office functions and improve customer interactions.
Before looking at how mergers can transform processes, it is important to understand the challenges that revenue cycle operators face. These challenges include:
These issues call for a reevaluation of RCM strategies, especially during mergers when systems and processes may be combined or adjusted to improve performance.
Mergers in healthcare can be significant for transforming revenue cycles. As organizations merge, they can streamline and integrate their processes, resulting in better financial outcomes. For example, Chartis has reported that its clients have seen substantial results from improved RCM practices, including a 6-8% increase in cash to net revenue, a 40-50% decrease in Discharged, Not Final Billed (DNFB) cases, and a 10-20% reduction in accounts receivable (A/R) days. These statistics indicate the potential for increased efficiency and revenue generation during and after mergers.
An academic physician group has set goals for optimizing its revenue cycle through strategic changes. They aim to save $17 million annually and increase net revenue by $15.6 million. These financial gains can enhance the organization’s bottom line and support better patient services and community health initiatives.
Chirag Bhargava, a Senior Partner at Chartis, points out that mergers present a unique chance to implement significant changes in revenue cycle management. He highlights that organizations open to these possibilities can improve financial performance and benefit the wider community.
Successfully transforming the revenue cycle involves careful planning and alignment with the organization’s strategic goals. Here are key steps to achieve this alignment:
By implementing these steps, healthcare organizations can create a more efficient revenue cycle that meets present demands and anticipates future challenges.
Technology, especially artificial intelligence (AI), is changing the revenue cycle in healthcare. New technologies enable organizations to automate tasks, improve data accuracy, and enhance interactions with patients. AI tools, such as those from Simbo AI, can manage front-office phone interactions, relieving administrative burdens and allowing staff to focus on more important tasks.
Automation through AI raises efficiency and ensures that patients have a positive experience from the start. AI systems can handle inquiries, schedule appointments, and answer billing questions quickly. This enhancement in workflow management decreases staff workloads and allows more time for patient care. As a result, organizations can enjoy smoother operations, reduced A/R days, and lower overall costs.
Furthermore, AI integration in revenue cycle management allows organizations to anticipate revenue collection trends, evaluate payment likelihood, and handle denials more effectively. This comprehensive method helps organizations adapt their financial operations while improving cash flow and revenue.
To effectively measure the impact of mergers on revenue cycle transformation, organizations need to identify key performance indicators (KPIs) that reveal success and areas for improvement. Important metrics to consider include:
Monitoring these metrics enables organizations to set benchmarks and evaluate the effectiveness of their changes, ultimately leading to better financial health.
Transforming the revenue cycle during mergers often depends on experienced leadership. Professionals with deep knowledge in revenue cycle management and technology, such as senior partners at Chartis, provide critical expertise. With their backgrounds in strategic planning, operations management, and technology integration, these leaders offer tailored advice to healthcare organizations facing mergers and transformations.
For instance, Phil DeSantis, another Senior Partner at Chartis, has spent nearly fifteen years enhancing revenue cycle technology. His experience highlights the importance of building strong processes that connect business and IT teams. This collaborative effort ensures that technology aligns with operational goals, especially during organizational changes.
Chartis’s approach to revenue cycle transformation illustrates best practices that can benefit any organization considering mergers. Recognized as the 2023 Best in KLAS winner in Revenue Cycle Optimization, Chartis uses its industry knowledge to help clients navigate the complexities of transformation successfully. This skill is vital as organizations work to enhance their operations and financial outcomes in today’s challenging healthcare environment.
Mergers in the healthcare market provide an opportunity for organizations to better their revenue cycle management. By leveraging technology, streamlining operations, and aligning with strategic goals, healthcare providers can develop advanced financial systems that enhance performance and patient experiences. As organizations consider partnerships and changes, experienced leadership and commitment to optimized processes remain essential. The future of healthcare revenue cycle transformation looks positive as organizations prepare to tackle challenges and improve financial outcomes for their patients and communities.
The legacy perception of revenue cycle management as merely ‘billing and collections’ underestimates its complexity and importance, which includes cost management, regulation, payer contracts, and patient experience.
Revenue cycle operators face challenges such as cost management, shrinking margins, complex payer contracts, patient experience expectations, and compliance with government regulations.
EHRs can optimize revenue cycle processes by enabling automation, improving interoperability, and ensuring that data collection aligns with demographic and regulatory requirements.
Technology plays a crucial role in revenue cycle integration by maximizing investments, improving processes, and enabling a predictable patient financial experience.
Aligning the revenue cycle operating model with strategic priorities allows organizations to support overall goals, improve performance, and realize revenue potential at lower collection costs.
Chartis assists providers by transforming revenue cycle processes and optimizing technologies, helping them navigate challenges and achieve specific improvements.
Chartis clients have achieved significant improvements, including 6-8% cash to net revenue improvement, 1-3% reduction in avoidable write-offs, and a 40-50% reduction in discharged, not final billed accounts.
Mergers provide an opportunity to transform the revenue cycle into a next-generation system that benefits both the new entity and the larger community.
The senior partners at Chartis bring extensive experience in revenue cycle management, technology implementations, and strategic healthcare transformations, supporting clients with tailored recommendations.
Successful revenue cycle management enhances financial outcomes by reducing costs, optimizing billing processes, minimizing denials, and ultimately increasing net revenue for healthcare providers.
Simbo is using AI agents to automate all phone related workflows. Connect now to know more.
Schedule AI Agents Demo Now© Since 2019, Simbo AI.
