Executing on Source System Optimization and Change Management to Increase Revenue Cycle Effectiveness11/28/2018
AnalyticsCultureData GovernanceDeploymentEventsRevenue Cycle All posts

There are a number of steps involved with increasing the effectiveness of your revenue cycle. First, the processes in place are assessed and recommendations are laid out to create a go-forward strategy. Then, an analysis of the data available occurs to provide transparency into your operations and implement the tools necessary to perform various levels of analysis. Finally, based on the insights surfaced from the analysis, the strategy is carried out to improve the revenue cycle.

Executing on this source system optimization leads to a lot of change within an organization — both operationally and systematically — so this change needs to be managed to ensure a smooth transition to a system that is in place for the long-term future.

Source System Optimization

Optimizing your source system is where recommendations and analytics come together to change aspects of operations — resulting in peak performance and an enhanced revenue cycle. For example, if there is a recommendation for improving a workflow or improving some configuration within your Epic system, the deployment team uses the descriptive analysis to guide the changes made to the system.

Take for example capturing authorization numbers. In the U.S., authorization and precertification issues account for 18.2% of denials.1 These numbers can be stored in 12 different places, including notes, scans, and telephone call encounters. However, the numbers only attach to the claim in one spot.

To solve this denial problem, it requires understanding the workflow generating the 12 different places authorization numbers are stored and the limitations or hurdles of getting the information to the right place. To optimize a system that does not effectively handle this process, a good first step would be to create a work queue for visits that don’t have an authorization number in the correct location.

A prioritization grid is also a great tool to help guide the optimization process and ensure that the most important changes are made to your system first. This tool assigns values to tasks in terms of complexity, such as build complexity or an estimate of the hours it will take to complete, and the impact these actions will have, such as on revenue or efficiency gained. From here, you can focus on the tasks that will have the highest impact with the lowest complexity and work from there.

Take our free questionnaire to see how your revenue cycle performance stacks up against other healthcare organizations we work with.

Because multiple departments are affected by the system changes that will be put in place, there are challenges that come up when implementing the new system. This is where change management comes into play.

Change Management

Deploying these changes may be met with challenges along the process from various parties involved. Here we take a look at what those challenges are and how you can overcome them.

Resources

Typically, one of the biggest challenges that arise is from a resources standpoint. How the recommendation falls in terms of your priority with other projects going on can have an effect on the time and effort it takes to complete the project.

An organization may be understaffed, overworked, or doesn’t have time to make the changes — potentially all three at once. With other “just keeping-the-lights-on” sort of tasks that they are responsible for, the system optimization could be seen as more of a hindrance than a help at that point in time.

While there may be no straightforward fix for this hurdle other than bringing in more resources, you can still solve for this problem. Implementing these changes should be seen as a priority because it will lead to an improved system in the long-run — benefiting everyone involved. Allocating non-essential resources to complete the changes in a timely manner will also free up more resources in the future.

Team Disconnect

There can also be a disconnect between the different teams involved. When teams start the process of making the revenue cycle more efficient, they enter from an operational standpoint — assessing the systems in place and seeing where improvements can be made. But when the deployment phase of the recommendations starts, the execution happens on more of an IT side, so there can be a slight disconnect between the two parties.

Operations and IT have to be in agreement on the strategy going forward, otherwise, the system won’t be nearly as effective. The top priority for operations may differ from that of IT, so connecting with both sides and agreeing on the strategy and changes that will be implemented is essential.

Overcoming the disconnect between operations and IT can be accomplished by highlighting the return on investment or time saved by both parties. If the two sides can save time and resources in the future by having a heavy-lift in the short-term, then it should justify implementing the changes. HFMA shared an example of Michael Blaszyk, retired CFO of Dignity Health, reporting that one of his employees used to spend 30% of their time on the revenue cycle, but when they partner with an advisor to optimize their systems, that was cut to just 5%.2

With this time and money saved, departments can focus on more strategic initiatives rather than regular maintenance of the system in place. As our own Greg Cook, Director of Revenue Cycle Transformations, put it, “If this is going save the organization $10 million, and you’re telling them it’s going to cost $10,000 of resources time to implement, it seems like a no-brainer — let’s get it done.”

Optimizing your source system and managing the changes that come with it can be difficult — but it doesn’t have to be. At Prominence Advisors, our team has the experience, skills, and perspective to guide you through the complexities of your IT initiative to help you achieve your goals — contact us today.


 

 

Sources

  1. https://www.beckershospitalreview.com/finance/7-strategies-to-prevent-claims-denials.html
  2. https://www.hfma.org/downloadasset.aspx?id=52362
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