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RCM Workflows are Missing from Your EHR System

Amanda Parada
March 6, 2024
RCM workflows

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A traditional proverb states that “Opportunities neglected can never be recovered.”

When it comes to your revenue cycle, these neglected opportunities are accounts that fell through the cracks, and that translates to lost revenue. This happens quite a bit when managing your revenue cycle with your electronic health record (EHR) system. While a critical part of the clinical side of the business, EHR systems just aren’t built to handle the intricacies of the revenue cycle.

EHR systems don’t include the detailed workflows of a purpose-built revenue cycle management (RCM) solution that help organizations focus on working the right accounts at the right time to drive reimbursement.

Critical for clinical

As the digital age began, EHR systems grew in popularity and functionality. They were no longer merely a way to move away from paper records. Instead, EHR systems became dynamic systems designed to improve efficiency, accuracy, and patient care. They now securely maintain comprehensive medical histories, including diagnoses, medications, immunization data, lab results, and more. They also facilitate communication among different healthcare providers, streamlining administrative tasks and enhancing overall healthcare practices.

Today’s EHR systems provide:

  • Enhanced patient engagement
  • Data analytics for informed decisions
  • Enhanced security and compliance
  • Seamless integration with other systems

EHRs have revolutionized how healthcare professionals capture clinical data, reduce medical errors, protect patient records, and ensure data accuracy. That’s because they were designed to enhance the clinical process, not the revenue cycle.

All about efficiency

Staffing shortages and tightening budgets have highlighted the need for efficient workflows to guide your RCM operations.

With an estimated shortage of up to 3.2 million healthcare workers by 2026, including many in RCM departments, current staff is being stretched to their limits. These overworked individuals can benefit from a workflow platform that can automate time-intensive tasks, such as manual and repetitive inputting, processing, and evaluating of documents and data. This can help alleviate some of the workload on RCM staff, as well as eliminate human errors and allow employees to focus on more human-intensive tasks.

When it comes to hospital and healthcare organization budgets, RCM departments don’t often get the lion’s share, especially for technology. The average IT expense for revenue cycle management in U.S. hospitals is approximately $8.4 million. This expenditure typically constitutes around 3% of a hospital’s total operating expenses.

Increases in IT budgets most often go to clinical items, such as digital care. The next largest portion of the IT budget goes to cybersecurity, then comes operational expenses, such as staff training. And, with today’s current workforce shortages, hiring clinical staff is another high priority. That leaves little for RCM needs, including optimizing their back-end RCM workflows.

In short, RCM operations are forced to do more with less, and efficiency is the key. As such, revenue cycle-specific workflows are becoming a critical part of an RCM organization. Unfortunately, these revenue cycle-specific workflows are not built into your EHR system.RCM workflows

Built for the revenue cycle

While an EHR system was designed to help the clinical side of the house, it wasn’t built with specific RCM challenges in mind. And RCM departments are facing a plethora of challenges that, to many, seem overwhelming. These include the rise in denials, the continuing workforce shortages, spiraling labor costs, and more.

As valuable as the EHR system is to clinical operations, a purpose-built solution is becoming just as important to RCM operations. These solutions can help:

  • Eliminate data navigation slowdowns with aggregation of patient-, payer-, and account-level data under a single platform.
  • Accelerate the path to resolution through automation and omnichannel patient engagement.
  • Increase payer follow-up results through like-account groupings, simplified billing frequency management, account spanning, and an optimized insurance follow-up experience.
  • Create easily digestible visualization of performance KPIs at all levels of the organization.
  • Supervise, enable, and improve remote and in-office staff with superior workforce management and quality assurance tools.
  • Free up staff for higher-yielding activities with exception-based redundant task automation through RPA and AI technologies.
  • Reduce denials and write-offs by automating prioritized, optimized presentation of accounts for follow-up.
  • Create a seamless workflow environment through system-agnostic bi-directional integration.
  • Enable intelligent business decision-making through root cause analysis spanning the revenue cycle continuum.

Purpose-built RCM solutions provide real-time performance insights that allow staff to shift focus and priorities based on real-time needs, driving improved process adherence and quality assurance.

A better option

“The future depends on what you do today.”

This quote from Mahatma Gandhi can be applied to many situations but has important meaning for RCM organizations. Those who wish to optimize their revenue cycle and drive reimbursements must stop relying on their EHR systems for RCM workflows and use a purpose-built RCM solution instead.

EHR systems are important for front-end and mid-revenue cycle processes, such as scheduling and coding. But they lack the workflow intricacies that the back-end revenue cycle demands, which leave a lasting impression on your reimbursements and the overall patient experience.

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