Bottom line impacts from revenue cycle staffing challenges

While physician and nursing shortages get several headlines in evaluating the effects of a tight labor market on medical groups, the staff who help manage the revenue cycle can have significant impacts on workflows and an organization’s bottom line.

A March 21, 2023, MGMA Stat poll asked medical group leaders which revenue cycle roles were the most difficult to hire amid the ongoing staffing shortages for the healthcare industry:

• The most frequently cited difficulty was in hiring medical coders (34%), which is not surprising given the amount of specialized education and training compared to some other revenue cycle roles. The Bureau of Labor Statistics (BLS) already estimates that there are roughly 12,300 new medical records specialist roles set to be created between 2021 and 2031, or about 7% more than 2021 levels.
• Billers (26%) were the second most common response.
• Schedulers (18%) and staff to manage authorizations (15%) made up a third of all responses.
• Another 7% of practice leaders responded “other,” with many pointing to issues hiring:
  • Managers for specific areas of revenue cycle management (RCM), especially billing managers
  • Staff to handle provider credentialing
  • Front-office staff who verify patient information and handle place-of-service collections
  • Patient engagement representatives.

Additionally, several medical practice leaders noted that they had relatively few issues with staffing RCM roles on account of hiring remote employees and having “an abundance of candidates” each time they post a job in these areas.

The poll had 469 applicable responses.

A recent AKASA survey of more than 400 healthcare financial leaders sought to assess the top areas for attracting talent for non-coder job vacancies, finding that registrars, billing specialists and patient follow-up staff were the most in-demand roles for existing vacancies.

Quantifying the impacts of RCM hiring issues

Being short-staffed in your practice’s revenue cycle process can cause several problems that can negatively impact a provider’s revenue and financial performance.

1. Increased days in A/R: With fewer staff to manage accounts receivable, a practice can have a backlog of unpaid claims, leading to an increase in days in A/R, affecting the practice’s cash flow. This sort of disruption was noted in an Aug. 9, 2022, MGMA Stat poll, in which 56% of medical groups reported their time in A/R increased in 2022, often on account of staffing difficulties.
2. Increased denials: Short-staffed revenue cycle departments may not have the resources to manage denials effectively, resulting in an increase in denied claims. Difficulties adjusting to changes in coding and documentation guidelines during the COVID-19 pandemic, along with discrepancies between payers on their rules, led to nearly 7 in 10 (69%) of medical practices reporting an increase in denials in 2021 versus 2020, per a March 16, 2021, MGMA Stat poll, which found that practices with increased denials reported an average increase of 17% over 2020 levels.
3. Decreased productivity and morale: When staff are constantly working short, team productivity and morale may dip, resulting in more errors. Errors or delays in any part of the revenue cycle process will affect the practice’s revenue.
4. Missed opportunities: Short-staffed revenue cycle departments may not have the bandwidth nor the training to pursue or follow up on all available revenue opportunities. The practice needs to have staff available to correct coding errors, pursue underpayments, work denials timely, and review their KPI metrics for process improvement opportunities. According to 2022 MGMA DataDive Cost and Revenue survey reports (based on 2021 data), the median turnover rate of business operations staff was at 16.72% for multispecialty groups with primary and surgical care, with a hire rate for those positions at 16.78%. If you have a revolving door for your revenue cycle staff, your practice may struggle to meet and improve processes in the department.

There are several ways an organization can be creative in staffing revenue cycle positions:

1. Cross-training: Consider cross-training staff members to perform a variety of multiple revenue cycle tasks where possible. Roles such as Patient Access Representative, Billing Specialist, Accounts Receivable Specialist or Denials Management Specialist could be trained to cross trained, allowing for more flexibility and allow staff to grow.
2. Part-time or shared positions: Offering part-time or shared positions can provide flexibility for staff members who may have other obligations and can reduce the cost of hiring full-time staff, if you are struggling to do so.
3. Remote work: Offer remote work options for revenue cycle positions. This can expand the pool of potential candidates.
4. Technology solutions: If your practice has not already found a way to automate your revenue cycle, do so now! Automated billing systems or revenue cycle software can reduce workload and allow staff to focus on higher-level tasks. It also reduces paperwork errors that can occur.
5. Internship or apprenticeship programs: “Growing your own” is a way many practices have dealt with staffing shortages. An organization may want to consider starting an internship or apprenticeship program to provide training and development opportunities for individuals interested in revenue cycle positions.
6. Outsourcing: There are pros and cons to outsourcing your revenue cycle management department or even outsourcing only part of it. Either way, you will need to have a process in place and KPIs that you track to make sure that services are being delivered as expected.

It is important for organizations to assess their revenue cycle needs and resources to determine the appropriate staffing levels for their RCM department. Benchmarking against industry staffing levels as well as other revenue cycle management key performance indicators (KPIs) are ways to help ensure that your organization is maximizing revenue and cash flow, while minimizing denials and other revenue cycle-related challenges.

MGMA resources:

• Revenue Cycle Management: Don’t Get Lost in the Financial Maze
• Certificate Program: Revenue Cycle Management – on demand
• Podcast: “Deep dive into the revenue cycle with Kem Tolliver and Taya Gordon”

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