Introduction
“We are hiring”
This is a sentence most organizations in the healthcare industry are posting online and offline these days. While everyone is aware of the staffing challenges at the clinical level of the healthcare business, the backend challenges have largely been ignored to date.
Revenue Cycle Management services is the heart and soul of any healthcare business. It directly influences the profit margins and determines how efficiently bills are processed and reimbursements are collected.
The Revenue Cycle Management service industry has been one that was greatly affected by the pandemic and the process changes that resulted because of the pandemic. While many companies in other industries went out of business, Revenue Cycle Management companies had to contend with unpredictable patient flows, untangle the complications of Covid and telehealth and CCM (Chronic care) billing, and more importantly, handle the great resignation trend.
The great resignation has shaken the labor market globally, especially here in the United States. Here are a few statistics about this trend in the US market for you to get an idea of how things are right now. The stats are picked up from the US Department of Labor’s JOLTS report.
– As of the end of February 2022, there were 11.3 million industry-wide job openings in the country.
– In January 2022 alone, 4.3 million people quit their jobs across industries.
– Job resignations are 23% higher than they were before the pandemic.
While this is not healthcare specific, you get the flow! Staffing challenges are real and happening and are projected to affect the Revenue Cycle Management Companies in the coming years too. It is expected for this trend to increase hiring costs, forcing companies to pay higher wages to retain existing talent or hire new ones.
When the healthcare industry was already struggling with an overload of patients and unavailable staff, money lost due to denials and wrong reimbursements are the last things they need on their plate. How much can RCM services take up too? Large and small Revenue Cycle Management service providers are constantly struggling with increased workloads and complex billing and coding processes on one hand and staffing challenges on the other.
Billing practices and Revenue Cycle Management companies in the healthcare industry have faced and are facing a lot of challenges every single day. We have tried to capture some of these here.
According to the Centres for Medicare & Medicaid Services (CMS), as of February 2022, about 14.5 million people have signed up for or have automatically been enrolled under the Affordable Care Act. Three million of these are new individuals, while 11.5 million are return customers. Clearly, the pandemic has made people understand the need for medical insurance, and this trend is going to continue.
What does this mean for healthcare Revenue Cycle Management service providers? Their workload will increase and their clients will have more extensive and stringent demands. How can the industry match up with staffing shortages?
Until now, people have been the most important assets in an RCM process. Error-free coding, billing the right processes, HIPAA and other compliance checks, auditing, quality checks, handling denials, and converting claims to reimbursements are all done by experts who understand the field and know the tricks.
So what happens when the attrition rate is high?
Vital terms like denials rate increase and reimbursement rate, and the number of days in the A/R cycle dropdown. HRCM companies have to spend more time handling staffing problems, attrition, recruitment and onboarding, and exit processes instead of focusing on their core competencies.
Sources state that 86% of denials are potentially avoidable if the Revenue Cycle Management processes are created and run the right way! Your team plays a major role in altering the denials rate. The denials rate has already been steadily increasing since the pandemic. With sudden changes in mandatory terms and compliances during and after the pandemic, it is becoming easier for payers to deny reimbursements, keeping Revenue Cycle Management experts to think on their feet and maintain reimbursement SLAs.
Do remember that most companies invest in months of training for new and existing employees to keep them updated on what’s happening in the industry. These training sessions can be expensive and effortful affairs. What happens when hordes of employees quit right after your precious months of training? What happens when employees quit when you have just managed to sign a contract with a large client? All these are questions that need to be answered when you consider staffing challenges and their impacts on Revenue Cycle Management Companies.
All these above problems lead to delays in completing projects and extended deadlines, both of which may not sit well with the clients. Also, these will reflect as delayed A/R cycles and lower reimbursements rates, eventually affecting the cash flow and revenue cycle of the clients. If the A/R cycle is not stringent enough, practices that expend thousands of dollars a day on running expenses will crash.
Experts say that both Revenue Cycle Management companies and healthcare providers have to get used to adopting new RCM technologies to bring down the overall burden on the staff and streamline the process going forward.
Quintessence, for as much as we have depended on our human experts, has also been consistently investing in tech, constantly aware of what staffing challenges can do to an aspiring RCM service provider.
The general advantage of technology across industries is common knowledge. It reduces the chance of human errors, brings about automation, which is preferred and reduces the need for constant human intervention.
However, specific to HRCM and staffing challenges, the advantages are over and above these and directly impact the process success rate.
There are several ways we feel technology can handle staffing challenges.
Did you know that there are organizations that are using AI to give employees productivity scores? Artificial Intelligence can perfectly track employee movements, via a whole range of tools. Factors like mouse movements, keyboard strokes, the time the screen is idle, and the kind of websites the employees visit can all be used to create productivity stories. Such tools can also analyze the behavioural traits of people working there, giving the organization amazing insights about individual employees.
Right now, biller bill claims and coders create coders. The quality team oversees the process. How many of your employees take an interest in learning the entire workflow and move from a transitional role to a solution-oriented role? Technology can help achieve this. When employees come together to envision, design, monitor, and implement tools, they get more involved with the process and naturally get a skill up-shift.
A Healthcare Financial Management Association’s (HFMA) Pulse Survey Program conducted post-COVID-19 states that during the pandemic, 51% of RCM organizations found the work volume unpredictable. Having the right technology to back you up will help you handle work volumes like a pro, without struggling with understaffing problems. This will also ensure your employees are not overloaded, adding to their work stress levels.
The same survey compares the before and after effects of implementing Revenue Cycle Management automation in Nebraska Methodist Health System, a healthcare company in Nebraska. It states that after implementing Revenue Cycle Automation, the company was able to outsource the work of 19-full time employees to these tools, definitely saving considerable money in the process.
Technology, when implemented right, can help organizations retain back the cream of the workforce and supplement their skills with the help of tools and software. When organizations have to manage just a limited pool of employees, they treat them right, offer all the right benefits, and keep them happy and engaged. This is an indirect advantage of backing up on technology.
With technology like AI and automation to back the staff up, they can finally get away from monotonous tasks that drink up their time and energy. There will be space to redeploy human skills in places that actually make a difference, like in technical denials and claims.
There is nothing that kills creativity more than monotony. Adobe conducted a global study and concluded that 77% of employees think when organizations invest in creativity, it will result in happier employees. How better can you do this than by investing in tech to take over the monotonous jobs of your staff? We stand by our thought that by keeping your employees happy, you get to bring down the attrition rate and stay away from preventable staffing problems.
Technology can help combat trends like the Great Resignation that may come up in the future. It allows processes to run smoothly, despite over or understaffing issues. When technology like AI can take over some or most of the RCM processes, one person’s or a team’s delay won’t affect the entire cycle. SLAs can be maintained easily, thanks to consistent efficiency and results.
While this could be a slightly sensitive topic to discuss, there is no question that technology helps save the money spent on hiring, training, and retaining human talent. In an industry like RCM, learning is the key to succeeding, and that is why training and development are always costly affairs. Organizations always have to be aware of the fact that an employee could just walk away after the company spends thousands of dollars in training them.
Companies can save money by creating a balance. Wherever human talent and expertise need to be used, invest in training. In places where technology can take over, invest in a tool or software that does the job equally well, if not better.
According to the Society of Human Resource Management (SHRM), it takes about $4,129 to hire someone new across different industries. This was a 2016 report, and we can only assume the cost is higher now. Also, the same report says that it takes about 40-42 days to fill a new position. All these are time and financial expenses for organizations that can be avoided by leaning towards technology.
Technology can be a game-changer in handling unpredictable staffing challenges that may arise time and again in an HRCM setup.
Here are some stats to round up this discussion.
Hospitals that use integrated RCM, EHR, and PM tools manage to collect up to one-fourth more on billed charges than practices that don’t have such systems integrated.
A Black Book Research survey done before the pandemic in the USA stated that one-fourth of hospitals across the USA don’t have a robust RCM solution in place. Few depend on simple internal billing systems, while others with existing RCM systems mask their efficiencies by staying away from tech upgrades or depending too much on manual human-led processes.
Organizations that want to move to a better RCM system find their employees either unskilled to learn and implement the new changes or unwilling to make the change, fearing technology will take up their jobs. Revenue Cycle Management service providers have to start by assuring their employees that technology changes are to assist and not completely replace them.
Human skills will always be integral to revenue cycle processes, and there are no two ways about this. The human mind can achieve things impossible. However, the mind needs the time and space to achieve greatness, and these tools can help get this done.
