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Tune up front-end RCM processes to capture more revenue with less effort and lighter administrative burden

Insight Article - March 29, 2022

Quality & Patient Experience

Coding & Documentation

Billing & Collections

Reimbursement

Business Operations Technology

Christa Lassen-Vogel
Medical groups are facing unprecedented cost increases as well as lost revenue that can never be recaptured. While many groups focus on back-of-house revenue cycle management (RCM) improvements to improve profitability, both research and case studies show that breakdowns in patient-facing interactions at the front end of the patient encounter are where the biggest revenue losses occur.
 
In February 2022, Juli Forde Smith, Director at ZOLL® Data Systems, presented an MGMA webinar on how medical groups can reduce the administrative burden on front-end, patient-facing staff while at the same time, improving the profitability and financial health of medical groups. She highlighted specific financial and administrative challenges through case studies and the latest research and provided tangible strategies for reducing losses that occur in the early stages of patient interactions and ways to optimize reimbursement.
 
The top challenges faced by medical groups include:
  • The RCM process: Tracking, identifying, collecting, and managing incoming payments is more complex than ever. Contracts with payers, legislative mandates, and managed care are changing so frequently that it’s hard to keep up.
  • A healthcare worker labor shortage: By 2026, it’s estimated that the United States will be facing a shortage of 3.2 million patient-facing healthcare workers (front desk staff, schedulers, etc.).1 This pending scenario means it’s critically important for medical groups to take meaningful action now to streamline how they schedule and register patients, gather patient health and insurance information, and manage accounts receivable (A/R) processes.
  • Healthcare worker burnout: The American Medical Association reports that 48% of U.S. doctors reported burnout in 2020, with other health professionals reporting even higher levels.
  • Costly errors in early-stage patient engagement: Claim denial rates have skyrocketed during the COVID-19 pandemic. The average claims denial rate has risen by 23% since 2016. Roughly 50% of denials stem from issues at the front-end patient engagement stage.2 As a result, it behooves managers of medical groups to place special focus on front-end patient interaction processes. The number one impact of these universal breakdowns in early-stage, front-end patient interactions is billions of dollars in lost revenue for groups nationwide.
  • Disappointing financial performance of medical groups: As operating costs and losses increase, burned out physicians are facing lack-luster financial performance of their practices.
 
According to Smith, the areas that offer the strongest opportunities for mitigating losses and improving revenue capture include:
  • Patient engagement process improvements
  • Deployment of technology that reduces claim denials
  • Insurance verification process improvements and automation
  • Modified A/R practices that help increase Medicaid reimbursement
  • Restructuring financial assistance policies and programs
  • Training front-end staff to better deal with payment issues
 
While medical groups often focus on back-end operations to improve operations and financial strength, the numbers don’t lie. Some of the biggest areas of opportunity for improving profitability and patient care are tied to improvements in the front-end patient engagement processes. In her webinar, Smith delved into strategies for seizing these opportunities and offered actionable recommendations for medical groups to implement changes. To learn more, watch the webinar recording: Reducing the Burden of Patient-Facing Administrative and Revenue Cycle Tasks

Notes:

  1. “US Healthcare Labor Market.” mercer.us, accessed 18 March 2022.
  2. “The Change Healthcare 2020 Revenue Cycle Denials Index.” changehealthcare.com, accessed 18 March 2022.

About the Author

Christa Lassen-Vogel
Senior Manager ZOLL® Data Systems
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