Healthcare revenue cycle optimization: 4 facts to set the stage

This is the first post in a new Waystar blog series: 7 steps to sharpen your healthcare revenue cycle.

Don’t want to wait for a new blog each week? Download the eBook to learn 7 steps for maximizing your healthcare RCM software.

When your organization is looking to launch healthcare revenue cycle optimization, you need to know what you’re facing.

Some challenges are familiar, such as complex regulations or the pressure of payer reimbursement. Others are still unfolding, such as the lack of clarity surrounding virtual-care payments.

Before you dive into healthcare revenue cycle optimization, here are four challenges to know.

HEALTHCARE REVENUE CYCLE OPTIMIZATION CHALLENGE:

1. Patients are now the payers

Commercial payers have transferred a significant piece of financial responsibility for healthcare to patients. A $5,000 deductible — once considered “high” — is now standard, propelled by employers demanding more healthcare coverage for less money. That puts a bigger financial burden on the patient than ever before.

How do you respond to this trend?

Adopt a new approach to revenue cycle management (RCM).

Today, it’s imperative to understand — and collect — each patient’s financial responsibility for your services. A crucial part of that process is making it possible for patients to pay how and when they can.

If your revenue cycle processes don’t account for those facts, it’s time to adapt.

HEALTHCARE REVENUE CYCLE OPTIMIZATION CHALLENGE:

2. We’re living in a post-pandemic world

The effects of the COVID-19 pandemic will be studied long beyond our lifetimes, but two initial impacts have already become reality:

Patients now expect a streamlined digital experience for healthcare services that’s simple and consumer centric.
The revenue cycle is no longer a back-office function separate from the organization; Instead, it is an essential component of care delivery.

For an industry that has long relied on phones and fax machines, this demand for engagement is a heavy lift. As healthcare organizations scramble to meet the new normal, resources are diverted from core revenue cycle functions, often because of financial challenges created by the pandemic. In addition to this reshuffling of resources, organizations are feeling the pain of increased authorization requirements and aggressive denials.

Why are these unwelcome tactics a reality?

In many cases, payers are trying to maintain the massive gains in stock prices created by the pandemic. That’s why working smarter not harder is not just a catch phrase; it’s a necessity.

HEALTHCARE REVENUE CYCLE OPTIMIZATION CHALLENGE:

3. Automation is no longer optional

As automation takes hold at all levels of the rev cycle, it’s vital for traditional billing protocols to interface with new, streamlined approaches.

Engaging with patients has proven beneficial — and, in the case of price transparency, necessary. However, intentionality will be the difference-maker when it comes to automation.

With a smaller staff following the Great Resignation, healthcare organizations can’t afford any missteps.

What does that mean for providers?

It means that the pressure is on organizations to keep their workforces trained. To harness the power of automation, staff must know how to use the tools, resources, and processes that are proven to ensure financial success.

HEALTHCARE REVENUE CYCLE OPTIMIZATION CHALLENGE:

4. Data doesn’t matter unless you can use it

Stakeholder scrutiny is at an all-time high. Government and commercial payers are measuring scores of data about healthcare organizations. And if, for some reason, payers aren’t measuring that data? They’re expecting healthcare organizations to — and to report on it.

Because organizations are paid to provide value — and share in the risk to deliver it — data is vital to both external stakeholders and internal intelligence.

How can leaders optimize their top line?

Leaders must ensure their systems and processes allow for timely, accurate data extraction. Navigating complexities in the revenue cycle and pulling out usable data is the key to actionable insights.