Navigating healthcare reimbursement challenges with data and automation

Inovalon recently discussed providers’ healthcare reimbursement challenges with HFMA experts Shawn Stack and Erika Grotto. From navigating new regulations coming into effect soon, to continuing to focus on staff retention and patient engagement, there’s no shortage of things to be done – and many tasks can impact the revenue cycle in some way.

The following summarizes what healthcare leaders have shared as the biggest hurdles – and opportunities – for providers in their revenue cycle recovery efforts.

Navigating thin margins, growing denials, and reimbursement challenges

In his INOvators episode, Shawn Stack highlighted razor thin margins and price transparency as major areas of focus for providers right now. Particularly for hospitals, balancing supply costs and labor costs with revenue growth is a difficult task. Add in increasing claims denials and revenue recovery becomes even more challenging – making streamlined, efficient RCM processes all the more valuable.

Julie Lambert, President and General Manager for Inovalon’s Provider team, echoed this in her discussion with Erika Grotto of HFMA. Their podcast emphasized how enhanced RCM workflows are so critical to the challenges providers are facing – from the complexities of each individual payer’s coverage verification and claims submission, to rising denials. Having the right processes in place, with greater visibility to RCM problem areas and successful workflows, is no longer an option for providers. This is the missing piece in their revenue recovery efforts to go from operating in the red to getting back on track.

The staffing effect

As with most revenue cycle discussions in this era of healthcare, leaders cannot focus on processes, data, and automation alone. Growing employee burnout and staffing shortages also contribute to healthcare reimbursement challenges and must be addressed.

To ease employee burnout, RCM leaders can encourage providers and coders to work better together, reducing human error and increasing accuracy and ease throughout the revenue cycle. For example, sometimes physicians don’t know why coders ask them for clarification, but the language the physician uses is too open for interpretation – and coders need clarity to ensure accurate billing. As this issue persists, it creates a hole for billers to dig themselves out of, and a wider gap between RCM and clinical staff. This inconsistency can lead to over-coding or money left on the table, and down the line, makes it harder for teams to align after being siloed for so long.

Additionally, RCM and clinical leaders can start resolving staffing and burnout challenges by setting better priorities and celebrating team players who drive energy and excitement. This sets their teams up for success individually, and that increased engagement helps them better collaborate on their coding, process, and other reimbursement challenges.

Strategies for revenue cycle recovery

While there are many recommendations in the marketplace for providers to improve their RCM workflows, two of the most important drivers for success are prioritizing data and automation.

Visualizing the health of your RCM

Understanding claims, remittance, and workflow data gives providers the big-picture view of the revenue cycle that they need to make impactful process decisions. With Inovalon’s real-time RCM dashboards, providers can benchmark and monitor their performance across all their staff and workflows.

For example, if a provider is seeing more and more denials, they no longer have to wonder why or guess and check a new approach until they see those denials go back down. Instead, the denials scorecard within RCM Intelligence proactively and clearly highlights the most common reasons for the provider’s denials, allowing them to put strategies in place to address the areas of greatest opportunity and take corrective action within your team’s workflow.

Billers and RCM leaders can then monitor the positive impact of their workflow adjustments with daily, weekly, and monthly revenue projections, giving them real-time, clear visibility to their revenue cycle recovery.

Replacing mistakes with workflow automation

Automating RCM workflows empowers billers to do more with less, and to potentially fill vacancies on their team that may be impacted by staffing shortages. This gives staff greater efficiency and peace of mind. Workflow automation helps them take back control of their day without missing any key details in the front- or back-end of the revenue cycle.

This also offers the opportunity to focus more time on other key tasks – such as educating patients on their coverage and co-pay, cross-training staff to be able to do more to support the revenue cycle, and discussing RCM trends and further opportunities for improvement with leadership, to introduce more ways to continue revenue cycle recovery.

The power of data and automation reaches beyond the direct revenue cycle impact, helping providers improve their staffing in response to employee burnout. Staffing doesn’t have to be done in spreadsheets anymore. With cloud-based solutions such as Inovalon’s Schedule Management suite, providers are turning hours of scheduling and daily last-minute staffing needs into proactive, streamlined staffing strategies. Data visibility and automation help staffing leaders understand their upcoming patient-staff ratios, staff overtime and credential needs, and even flag when agency staff is necessary to fill any gaps.

Take back control of your revenue and staffing with Inovalon

Inovalon is here to help. With a complete suite of SaaS solutions for providers, our front- and back-end RCM software, workforce management applications, and care quality solutions are here to make your organization more manageable and profitable.

Contact us today to learn more about our software for acute, post-acute, and ambulatory providers.

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