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Four Steps to Physician Revenue Cycle Transformation

Amid all the talk of Stage 2 Meaningful Use, Value-Based Care and ACOs at the HIMSS conference in Las Vegas last week, it was easy to overlook the dominance of the longest lasting trend of all in healthcare IT. Revenue cycle management doesn’t generate as much buzz as health reform but it’s still priority No. 1 for hospitals and physician practices nationwide.

It’s easy to see why. As the latest Obama Administration budget indicates, reimbursement from payers including Medicare and Medicaid continues to decline. As a result, self-pay is on the rise, even as it is becoming harder to collect payment from patients, many of whom are struggling just to hold onto health coverage for their families.

In this environment, effective revenue cycle management has become more important than ever. For help, many leading medical groups are turning to a new generation of sophisticated practice management applications and cloud-based RCM solutions. These end-to-end solutions not only increase automation, streamline workflow, raise clean claims percentages, and speed payments – they also provide actionable business intelligence that can transform revenue cycle operations and improve financial performance.

The Four Step Methodology

A white paper called “Four Steps to Physician Revenue Cycle Transformation” reveals how successful practices are using these technologies in tandem with a methodology designed to optimize their effectiveness.  The “Four-Step Transformation” methodology detailed in the white paper (also available from the Medical Group Management Association here)  distills best practices from hundreds of medical groups across the United States who leverage technology to improve their bottom lines.

Tim Terrell, chief information officer of Cornerstone Health Care, a 325-provider multispecialty practice based in High Point, N.C., is an advocate of the four-step approach. Cornerstone uses a state-of-the-art practice management system that also leverages analytic tools to help the practice spot problems in the revenue cycle quickly.

“The problems are always going to change because the billing game is constantly shifting ground,” Terrell points out. “So what you want from your revenue cycle system are the tools to automate the process, plus the intelligence to reveal problems, and then the ability to respond and address them quickly. It’s a never-ending process but one that reaps big rewards.”

The Four-Step Transformation methodology derives from the steps taken by many successful physician practices that have optimized their revenue cycles:

  • automate the basic RCM elements using practice management technology
  • apply analytics and business intelligence to the data generated by automation, uncovering meaningful insights
  • leverage insights to fix problems in the revenue cycle operation
  • constantly refine the process in a continuous quality improvement sequence

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