Collaborative Approaches to Enhance Revenue Cycle Performance: The Importance of Cross-Functional Collaboration and Effective Partnerships with Technology Vendors

Medical practices and healthcare systems in the U.S. are facing serious money problems. Studies show that the average operating profits for hospitals and health systems are going down. Also, claim denials have almost doubled in recent years. By the end of 2023, 15% of initial claims were denied, compared to 9% in 2016. These denials delay payments and create extra work for staff who must handle resubmissions and appeals.

One big cause of this issue is the extra work from prior authorizations. Doctors handle about 45 prior authorizations each week. This costs care organizations around $6 to $11 per claim in administrative fees. Rising costs, more rules like Medicare Advantage’s new policies, and inefficient processes mean healthcare groups need to find new ways to manage revenue cycles.

The Role of Cross-Functional Collaboration in Revenue Cycle Management

Revenue cycle management involves many steps such as clinical documentation, coding, billing, handling claim denials, compliance, and helping patients with their bills. When teams work separately and don’t share information or goals, it often leads to duplicated work, poor communication, more claim denials, and slower payments.

Working together across departments helps fix these problems. It makes sure everyone knows their role in improving revenue. For example, Saint Francis Health System started weekly meetings with teams from billing, clinical documentation improvement (CDI), case management, and patient financial services. These meetings found the main causes of denials and sent authorization problems to the right teams. This lowered mistakes and lost money.

Similarly, healthcare providers like Sharp HealthCare worked closely with health plans by giving them real-time access to Electronic Health Records (EHRs). This cut down medical record requests and claim denials. It led to better payment rates and an extra $2 million in revenue during problem-solving times. Such teamwork between departments and outside partners is important to improve both operations and money results.

Some key performance measures linked to good collaboration are:

• Clean claim rates: Making sure claims are correct and complete before sending them reduces denials.
• Days in accounts receivable (A/R): Cutting the time it takes to get paid helps cash flow.
• Denial rates: Fewer denials show that claim rejections are well managed.

By agreeing on these goals and tracking them across teams, health systems can create openness and responsibility. This supports better teamwork and quicker fixing of problems.

Effective Partnerships with Technology Vendors

Just using technology is not enough to improve revenue cycle results. Working with vendors who understand healthcare is very important. These vendors offer Revenue Cycle Management (RCM) services like billing, denial handling, and training. This can greatly improve financial processes.

For example, partnering with vendors that offer AI-powered billing platforms can increase the number of clean claims. These platforms check codes carefully for accuracy and following rules. Healthcare organizations that worked with such vendors saw fewer denials and got paid faster. Vendors also provide constant staff training on changing payer rules, coding policies, and technology updates. This keeps billing teams performing well.

Presbyterian Healthcare Services linked payer contracts directly into their accounts receivable systems and made teams specializing in payment recovery. This vendor-supported project helped them recover over $3.6 million in underpayments in just five months. St. Clair Hospital started an online payment system that brought in $1.6 million in collections in one year. These examples show how technology with vendor support can improve financial results.

Healthcare practices should choose technology partners who focus on teamwork, give fast client support, and offer data-based denial management solutions. This approach helps providers not just install tools but truly use them to boost revenue cycle results.

The Impact of Organizational Culture and Staff Engagement

Besides technology, healthcare groups need to focus on staff motivation and responsibility in revenue cycle departments. Even the best systems don’t work well without skilled and engaged staff.

Organizations like ENT & Allergy Associates use goal-setting methods to set clear expectations for their billing and coding teams. This helps track progress with clear targets. Maureen Clancy from Privia Medical Group says engaged staff stay longer, which helps improve revenue cycle results.

OhioHealth Riverside Methodist Hospital offers career paths to help staff develop skills in revenue cycle work. This boosts both ability and loyalty to the organization. Geisinger Health System trains staff to be more empathetic when talking to patients about bills. This reduces disputes and helps payments come in on time.

By using these human resource ideas, medical practices can lower errors, talk better with patients, and improve money results.

AI and Workflow Automation in Revenue Cycle Management: Streamlining Processes for Better Outcomes

Artificial Intelligence (AI) and workflow automation are becoming important tools for managing healthcare revenue cycles. These tools lower manual work, reduce errors, and let staff focus on tasks that add more value like handling denials and talking with patients.

Robotic Process Automation (RPA) is especially helpful for automating repeated billing tasks such as checking codes, submitting claims, and verifying prior authorizations. RPA cuts human mistakes by spotting missing or wrong data that often cause claim rejections. It can also prioritize denial appeals so staff work on the most important cases first, improving money recovery.

Generative AI looks promising for changing revenue cycle jobs. Experts say these tools could save the U.S. healthcare system $200 billion to $360 billion per year by making coding more efficient, managing denials better, and speeding up prior authorizations. But there are still worries about patient privacy, following rules, and the difficulty of adding AI to current systems. Many groups have not yet fully used AI’s power even though automation tools have existed for some time.

Another AI advantage is data analysis. Many health systems have spent a lot on Electronic Health Records (EHR) but do not use all the information stored well. By developing better data skills, healthcare providers can learn about denial trends, find blockages, and improve contract handling. AI systems can link claims data to payers, spot payment errors, and suggest process improvements.

Experts say health systems that build strong AI skills along with good vendor partnerships and teamwork will be better ready for future revenue cycles.

The Financial Benefits of Collaboration and Technology

With claims denials rising and administrative work growing, investing in teamwork and technology partnerships brings clear financial results. Integrated Delivery Systems (IDSs) show this by having only 34 net days in accounts receivable, billing patients quickly within 3.1 days of discharge, and very low bad debt write-offs of 0.2%. Point-of-service collections near 48% show strong upfront payment, helped by better registration and payment methods.

Lowell General Hospital raised point-of-service collections to almost 54% in one week by using pre-registration calls and outreach. Virginia Eye Institute cut registration times in half by using kiosks. These changes improve cash flow and greatly cut down administrative work.

Breaking Down Silos to Address Denials

Payer denials are still a big problem, especially with Medicare Advantage plans denying 17% of in-network claims, 24% of authorization requests, and 37% of medical necessity claims. Denial appeals can cost organizations up to $181 each, so managing them well is important.

Work silos make denials worse. Separate teams for coding, documentation, billing, and denials that don’t share goals or communicate often repeat work, delay payments, and lower staff morale. Cross-functional teamwork fixes this by creating shared workflows and common performance goals.

Training different departments together is also helpful. Teaching revenue cycle and clinical staff about each other’s jobs, especially in documentation and coding, helps lower mistakes that cause denials. Also, training doctors on correct and timely documentation is key to avoid unnecessary denials.

Practical Steps for Medical Practice Administrators, Owners, and IT Managers

• Hold regular meetings with finance, clinical, and admin teams to work on revenue cycle problems like denials and authorizations.
• Set shared key performance indicators (KPIs) for clean claims, denial rates, and days in accounts receivable to track results and assign responsibility.
• Invest in strong RCM technology that connects with EHRs and uses AI and automation while using vendor knowledge.
• Work with reliable RCM service providers who offer ongoing training and denial management support tailored to your practice’s size and type.
• Focus on staff motivation and growth with training on financial communication and clear career paths to improve results and keep employees.
• Encourage doctors to join education programs to improve clinical documentation and meet payer rules.

By combining teamwork across departments, good vendor partnerships, and the right technology, healthcare providers in the United States can improve revenue cycle processes, reduce financial risks, and help their organizations stay strong for the future.