From Minimizing Denials to Minimizing Risk: How to Move RCM Out of the Back Office

RCM Risk Management: 3 Ways Point of Care Tools Can Help Your Revenue Cycle Evolve

Most healthcare revenue today is tied in some way to quality and cost performance measures across the care journey. While slowed by the pandemic, the shift from fee-for-service to risk management in healthcare is continuing, making it important for revenue cycle management (RCM) leaders to consider how their role should evolve as reimbursement models do. This means ensuring that their focus shifts from minimizing denials to minimizing risk, which requires forging stronger connections between their teams and clinicians to take a more holistic view of care and costs.

doctor writing notesHere are three ways that your healthcare organization can use risk management tools to adopt revenue cycle management best practices so you can better manage risk.

  1. Enable clinicians to easily capture their service details at the point of care so that care, productivity and quality metrics and associated revenues are more closely aligned and accurate from the start.
  2. View care and financials from the perspective of an episode of care or the entire care journey rather than as a single service.
  3. Give clinicians and administrators trustworthy, real-time data and insights they can easily access and use to benchmark their performance against others in the practice as well as against other practices.

Let’s look at specific areas where a point-of-care tool could help RCM leaders achieve these objectives.

1. How can RCM teams coordinate with clinicians to contain costs?

No matter what payment models exist in your organization, you’ll always need good data that measures how efficiently and effectively you’re providing care. Coding and billing departments can give physicians a tool like Ingenious Med’s application to enable them to easily enter charges at the point of care — a critical starting point to give organizations timely, accurate, and detailed insights into the cost of their physician resources. This data can then be turned into key metrics such as readmission rates, case types, physician productivity, length of stay, total cost of care, and more.

healthcare collaboration between doctorsToday, many physicians are compensated based at least in part on productivity, and a growing number of physicians have a quality incentive package. Your RCM partner should be able to help you compare your current quality practices to the requirements established by various payers and programs. The Ingenious Med app can direct physicians to follow those practices for each relevant patient cohort and even query them to see if they did, in fact, comply with a value-based care model.

For example, if CMS has established prescribing aspirin as a standard quality practice for patients diagnosed with heart failure, the app can prompt providers to follow that practice and query whether it was administered, serving as a reminder to meet and document accepted quality practices.

2. How can RCM help to coordinate patient care and workflows across the care journey?

Both the literature and customers report that skilled nursing facilities are critical to their efforts to effectively manage care and prevent unnecessary readmissions, yet communication and care coordination often fall apart at this point. Ingenious Med’s tools transfer detailed patient care information from the acute care facility to the post-acute facility immediately upon discharge. That’s enormously helpful if the discharging doctor does not complete the discharge summary until later that day or even days later.  In that case, the intake doctor lacks the essential information — such as prescriptions and discharge instructions — he or she needs to appropriately treat that patient. Ingenious Med’s application includes cross-cover fields that contain a copy of that information and automatically transmit it to the SNF upon transfer. The clinician who then picks up that patient has the information he or she needs to ensure continuity of care.

ingenious med mobile crosscover

To assist clients that participate in bundled payment care initiatives, Ingenious Med offers direct integrations with the bundled payment conveners. The solution offers workflows that evaluate BPCI candidacy based on real-time patient data and then, enlist patients that meet those criteria into the convener’s care and management programs. For example, heart failure patients are often in bundled programs. Any time a patient record contains a congestive heart failure-related diagnosis, Ingenious Med sends a transaction to those conveners, who then automatically enlist those patients in that care program.

For patients that already have active episodes, the conveners are notified and can then deploy a nurse or case manager to make sure that that patient’s care is being managed appropriately. For example, they can make sure patients are seen in a follow-up appointment after discharge, and/or that they are taking prescribed medications. These actions can prevent an unnecessary ED visit or hospital readmission that negatively impacts patient health as well as risking the provider’s financial viability.

3. How can RCM deliver timely, trustworthy performance insights to administrators and clinicians?

Succeeding in risk-based contracts requires having access to real-time data based on the actual services rendered as soon as they’re rendered. If performance is based on claims data, you have likely lost a month’s time for gaining insights into any issues or taking corrective action.

Length of stay is a key metric in value-based care contracts. Ingenious Med can help providers meet length of stay (LOS) targets by giving doctors a visualization that shows the patient’s progress toward the expected discharge date for their particular diagnosis, condition or procedure. If the LOS has exceeded that expected discharge date, components within the patient’s records turn red to draw attention to the delay. The physician can then review the patient’s case and, where appropriate, update the diagnostic information to indicate that the patient’s condition is more complex than initially indicated.

Ingenious Med also provides reports that enable healthcare organizations to track readmission rates, which can undermine success in risk-based contracts. If you have an efficient discharge process in which patients are being discharged sooner than the average length of stay, it may appear that you’re operating profitably. However, if too many patients are then readmitted, you have caused more harm than good to your bottom line.

doctor on phoneAnother tool Ingenious Med offers is admitting and discharge notifications. Whenever a patient is admitted to a hospital, the tool automatically notifies that patient’s primary care provider and asks them to contact the patient’s attending provider if they have relevant information that could improve the patient’s care. Our secure chat capabilities also foster clinician to clinician collaboration.

To be impactful, performance data needs to be shared appropriately across the organization. Ingenious Med offers different levels of real-time performance reports that can be configured to address each client’s unique needs as well as the different needs of physicians, group leadership, and C-suite leaders. These include real-time operational reports, enterprise level reports that contain aggregated data to provide a snapshot across and among each group, facility and/or individual physician. That enables medical directors to know which providers are having issues and to be able to engage sooner rather than later.

But perhaps most important is the ability to deliver that information directly to each physician, enabling them to benchmark their productivity and performance metrics against their peers. Providers can run their own productivity metrics, and given the competitive environment in most practices, this often is extremely useful in driving behavior changes that lead to improvement. Many providers report that they look at their productivity report every day.

Taking these three steps to shift your perspective and elevate the role of RCM in managing risk. Having a partner with an easy-to-use and robust point of care tool can help you get there faster and nearly painlessly.