RCM GENERAL QUICK HINTS

1. UNDERSTAND THE DEFINITIONS BEHIND THE METRICS
Every patient accounting system and every hospital defines metrics in slightly different ways. Don’t assume the figure means what you expect it to mean. Understand what goes into the number and what it means in context
Examples of this include:
A stock DNFB report might include accounts with lag, or only post lag.
AR or AR Days calculations might be skewed by inclusion or exclusion of credits.
2. UNDERSTAND THE RELATIONSHIP BETWEEN CASH AND NET REVENUE
Many CFOs focus on Net Revenue increases or decreases, but you can’t cash a check with Net Revenue.
Improved Cash should relate to improved Net Revenue, but you should understand what the impact of a given operational change might be on both Cash and Net Revenue.
3. IDENTIFY AND FIX PROBLEMS EARLY
Most problems will only get worse and require more time/effort/resources to fix as they progress through your collection process.
For example, getting an authorization right at registration might be difficult, but asking PFS to get a retro-authorization -- after a denial -- may be impossible.
4. ALWAYS SEEK THE ROOT CAUSE OF PROBLEMS
In many cases, information provided from sources outside the revenue cycle can cause failures and/or rework within the revenue cycle.
Don’t accept bad performance from clinical areas as a given.
Identify the source, understand the alternatives or solutions, and work within the organization to fix the problem where it occurs.
5. BENCHMARKS ARE GUIDELINES – CHANCES ARE YOU CAN DO BETTER!
Don’t think of a benchmark as the ultimate performance – often they are set at the 75th percentile, meaning plenty of people are doing far better.
Benchmarks are fine as a yardstick, but they should be a starting point, not an end point.
Seek out the barriers which limit organizational performance and address them head on.
Don’t accept the standard...SET the standard!