The financial challenges of running a health system, hospital or healthcare practice never seem to abate. Instead of getting a break as the pandemic transitions to an endemic problem and volumes normalize, healthcare financial leaders are instead facing the new challenge of inflation. The Bureau of Labor Statistics reports that 2022 year to date medical services costs have risen more than six percent year over year. That’s not good news for revenue cycle leaders in the face of potential 2023 cuts to Medicare payments, which could be four percent or more.
Staffing shortages and the rising costs associated with them have contributed to much of the pain, with no end in sight. McKinsey has projected that nursing shortages will be as high as 200,000 to 450,000 by 2025, along with a shortage of tens of thousands of physicians. Many health systems are reporting planned nursing salary increases of 20%. As a result, healthcare expenditures are predicted to increase over $300 billion in the next four years, with staffing costs accounting for about two thirds of the increase.
While staff shortages are most acute in clinical positions, financial healthcare leaders are also finding it challenging to hire and retain experienced and skilled staff such as billers and coders. A recent HFMA survey of CFOs found that half of respondents say it’s more difficult today to find qualified revenue cycle workers. And the problem isn’t expected to disappear anytime soon, with demand for medical record specialists and coders projected to grow nine percent annually through 2030, according to the U.S. Bureau of Labor Statistics.
Efficient financial workflow tools can help to address both issues
What can be done, then, in the face of shrinking margins and staffing challenges? While not a panacea, there are point of care tools that can streamline workflows, mitigate billing and collection issues, and optimize margins. These tools can save time and reduce frustration, which in turn can help to improve retention and reduce the considerable expense of replacing and training staff. They can also help to reduce billing errors, speed collections, and minimize compliance risks.
Look for proven platforms that can reduce work while optimizing reimbursement; your organization should expect to meet performance targets like the following:
- 24-hour charge capture
- 3-day billing turnaround
- <1% of charges under or over coded
- <3% denial rate
The right tools can improve performance in five ways:
1. Improve charge capture timeliness and accuracy
Mobile tools that can automate much of the charge capture process and integrate with EHRs help physicians quickly and accurately capture charges even when rounding at multiple facilities or delivering care in non-acute settings. Look for tools that can deliver key features like automated prompts, intelligent code filters, and menus customized to meet the needs of each specialty and practice. For example, the MasterCoder function in the Ingenious Med application improves clinicians’ ability to consistently enter the correct E/M codes. Also seek tools that can track all patient care episodes through real-time census and appointment data feeds.
2. Speed billing while reducing denials
Having a point-of-care tool like Ingenious Med enables revenue cycle staff to submit bills within just a few days, while improving documentation and tracking missing information to simultaneously reduce denials. The tool automates many otherwise time-consuming and error-prone tasks, including:
- Notifying providers of possible missed bills through in-platform chat, visual indicators, and push notifications
- Automatically finding missing charges based on clinical documentation feeds
- Automatically assigning missing bills to providers who create notes without corresponding charges
3. Reduce external audit risks and ensure compliance with all applicable regulations
One way to reduce audit risk is to perform an internal charge capture audit (the OIG recommends an internal audit of five to 10 random charts per provider per year). Look for a charge capture tool that can fully monitor performance across the enterprise with a comprehensive data set and sufficient parameters to make informed comparisons without needing outside data analysts.
Note that RCM staff will have more time to perform these internal audits when physicians and other clinicians are empowered to enter most charges quickly and accurately at the point of care.
4. Easily capture, analyze, and report performance metrics
Ingenious Med has advanced reporting capabilities to help practices and health systems monitor numerous critical metrics, including RVU count, patient team assignments, volume, utilization, coding and more. Armed with this data, healthcare administrators can easily compare individual, practice, and organization performance and monitor trends to better view and understand their underlying causes.
Physicians often modify their behavior in response to peer comparisons when they have timely, credible data in hand. Point of care tools where they’ve entered the data themselves facilitate the benchmarking process. Administrators can analyze E/M codes by variables such as history, physical examination, discharge, progress notes , or total RVUs, to narrow the focus to particular individuals.
Using real-time mobile and web-based dashboards can facilitate timely performance assessments and associated bonuses, helping physicians see a direct tie between their performance and income. Some Ingenious Med customers use incentives and/or penalties to help them achieve target charge and billing results; one customer improved charge capture by penalizing physicians who failed to enter charges within 10 days of service delivery.
5. Support standardization and scalability
Point of care tools also support more rapid standardization and scaling across a healthcare system or group of practices. Each time a new company, practice or hospital joins the system, having centralized, standardized billing functions and data formats in a single, unified platform makes it much faster and easier to absorb the new entity or to gain economies of scale in new markets.
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