Observation Deck

Managing Your Revenue Cycle

Advanced analytics and best practices take you everywhere you need to go.

• By Rob Boeye
• Jun 01, 2019

When it comes to your revenue cycle, sure, cash flow is king, but the HME providers who are managing their businesses using data are proving to be more successful than those who don’t. In fact, two recent studies by IBM show that enterprises that apply an advanced analytics solution have 33 percent more revenue growth and 12 times more profit growth. These enterprises are also more than twice as likely to outperform their peers. Well, if they can do it, so can you. By incorporating revenue cycle management best practices and advanced analytics to capture missed revenue, operate efficiently, and grow your patient base, you’ll be equipped to lead your business everywhere you need it to go.

After all, at the end of the day, everybody’s priority is to make sure patients are taken care of and referral bases are growing. But limited resources make it difficult to arm your staff with the level of experience needed to stay on top of billing and collections and the moving target of regulatory compliance.

Outsourced RCM?

This is why more and more HME providers are considering revenue cycle management services for their business. A strong services organization deploys what you need, when you need it. That includes providing the level of technical knowledge and expertise to monitor and adapt to regulatory changes and payer guidelines and to conduct a quality review of the sales order prior to confirmation.

It also means working any electronic rejections from both the application and the clearinghouse, working denials coming from payers, making sure A/R is being followed up on and posting cash so that you can focus on taking care of patients as you’re scaling your business.

Some providers might initially shy away from outsourcing revenue cycle management services because of the cost. But when you take a closer look, this is a variable cost versus the fixed cost of traditional staff. As your business fluctuates month to month, your fee is dynamic, which makes it much more cost effective.

And with advanced analytics tools that go hand in hand with your revenue cycle management efforts, you’re able to track and monitor productivity on a regular basis. As an example, your in-house or outsourced team is already working toward clean claims and collecting on A/R, and analytics then gives you deeper insight to help you understand what’s happening so you can take the right level of action to continue to follow up and collect on it. With operational metrics within analytics to measure each part of your revenue cycle operations, you always know what’s happening at each stage of your operational process through constant feedback for the greatest success.

At Brightree, we’ve introduced several innovative new revenue cycle analytics metrics to the market beyond the standard ones such as DSOs and aging AR. For instance, our Revenue Cycle Analytics offering focuses on what we’ve termed the 90-day roll, which moves beyond clean claim ratio to how much of your A/R is falling into a 90-day bucket. Your ability to focus on reducing the 90-day roll means you’ll get paid faster and you’ll have less A/R building up.

We also built into Revenue Cycle Analytics a metric that looks at orders that are taking more than 15 days to confirm in any given month. You can determine if it’s a particular payer or product or some other operational reason why it’s taking so much longer to confirm orders.

And a third metric that we look at very closely is the combination of credit adjustments and write-offs. This gives you insight into what you’re leaving on the table and the additional work that your limited resources are having to do.

These are only three examples of ways we’ve taken metrics beyond the basics. But part of the beauty of our Revenue Cycle Analytics is that it gives you the tools for analysis that then allows you to look at things differently and potentially even come up with your own set of metrics to fit your organization’s specific needs.

So, while the technical expertise you gain with revenue cycle management services is powerful in its own right, coupling these services with revenue cycle analytics gives your management team the visibility it needs for business-critical decisions and overall success. Often, you’ll have these insights in a matter of seconds, and this computation and visualization happens on an ongoing basis, so you have full visibility on how well your operations are doing at any given time.

Think of it as a constant feedback loop of insights for your operations to tweak their process. Analytics identifies a problem area or bottleneck in some part of your process; revenue cycle management fine-tunes its practices based on that information; and analytics shows the gains from the changes that were made.

Best Practices to Implement

Whether you’re ready to make a move now or just starting to contemplate the steps you need to take to make your revenue cycle operations run more efficiently and profitably, consider these 4 best practices.

1. Don’t leave money at the table. Whether it’s orders that you haven’t been able to confirm that are creating a backlog, non-billable revenue that is held up in your system or payer denials, advanced analytics can give you the insight you need to address the issues and take steps to prevent write-offs and credit adjustments in the future and to find that hidden money.

2. Clean intake management. As orders are coming in, there are best practices that give you a higher chance of actually getting paid the very first time that the claim goes out the door. These include making sure you have collected up-front the insurance information and the right documentation such as a CMN or prior authorization.

3. Go beyond the basics. Find a technology provider who understands what drives your business, what you should be looking for, and the knowledge gained through working with other HMEs. And then make sure they use innovative ways to solve your revenue cycle woes.

4. Level the playing field. Building revenue cycle analytics is a big expense, so small to mid-size providers can increase their ability to compete by tapping into solutions like Brightree’s Revenue Cycle Analytics, which was built by listening to the input from hundreds of providers.

While there’s still a runway for what revenue cycle management and analytics can do in the future (think: predictive analytics) as the technology continues to evolve, teaming up with a technology provider today puts you on the front end of those benefits so you can reach your end game all the more quickly.

This article originally appeared in the June 2019 issue of HME Business.