A technology-driven hybrid approach to overcoming coding and RCM staff shortages
Exacerbated by pandemic-induced burnout, resignations and even layoffs1, chronic shortages of coding and revenue cycle management (RCM) staff are forcing healthcare organizations to find ways to maintain revenue flow despite a lack of qualified professionals to manage critical processes. This is a situation that has been brewing for years, as too few qualified professionals are entering professions that are growing faster than ever.
According to the American Hospital Association (AHA), medical records, billing and compliance are the fastest growing white-collar healthcare administrative occupations, and are expected to grow 13% by 2026.2. Additionally, the Bureau of Labor Statistics (BLS) predicts that the number of medical records specialists and coders will increase by 9% from 2020 to 2030.3.
The growing cost of despair
The worsening shortage and the resulting short- and long-term impacts put resolving staffing issues at the top of the priority lists for many health information management (HIM) managers, revenue cycle managers and CFOs whose organizations are already under extreme financial pressure and tighter regulation. uncertainty and audit control4. Across all healthcare jobs, turnover has increased by nearly 5% over the past decade5contributing to longer billing and reimbursement times, as well as increased recruitment, integration, orientation and retention costs.
The Commonwealth Fund reports that a quarter of hospital spending (~$215 billion) comes from administrative costs such as marketing, administration and salaries of employees responsible for coding and billing.6. Greater competition leads to higher recruitment costs, which already account for around 20% of a coder’s salary.
Desperation to fill staffing gaps can often lead to the “hot body syndrome” method of hiringseven, which can only add to the damage – and expense – in the long run. A smarter strategy focuses on optimizing the productivity of existing teams to avoid burnout by adopting a hybrid approach combining outsourced services with technology, augmenting in-house teams with outsourced coders, and emphasizing on automation wherever possible.
Such an approach can improve revenue through increased collections, reduced delays and denials, and fewer days in accounts receivable.8. For example, outsourced partners are in a better position to identify coding issues that contribute to higher denial rates and offer insights into how these issues can be resolved before they impact the revenue cycle, without talk about scalable resources to meet patient volumes, workloads, bottlenecks and allowing internal staff to focus on value-added tasks.
The technology factor
Technology, especially artificial intelligence (AI) and automation, improves speed and accuracy and optimizes processes while freeing up internal resources to focus on core coding and RCM responsibilities. As a result, internal working hours at all levels are also reduced, as are the costs associated with training and continuing education. For example, low-skilled and repetitive tasks that do not require critical thinking skills are paramount for automation. Additionally, AI and automation can support back-end RCM processes such as clearing claims, identifying patient self-payment amounts, and alerting patients to amounts owed and collections electronics.
Comprehensive data analytics software can perform in-depth analyzes to provide visibility into crucial organizational metrics. Florida Hospital Automated Patient Pickup Notifications and Increased Teen Pickups to About 43%9. Texas Law Firm Saw 60-Day Accounts Receivable Drop 38% Just Three Months After Deploying Automation Solutionten.
Additionally, automation can reduce the need for review and query management and eliminate the need for spreadsheets. Additionally, advanced computer-aided coding (CAC) now leverages AI to speed up coding decisions, and CAC compliance software integrates with RCM workflows to automate auditing tasks.
A path to success
The tangible results delivered by AI and automation have been a driver of recent automation adoption – which grew by 12% between 2020 and 2021. This is according to a survey which found that 78% of healthcare systems currently use or are in the process of implementing automation in their revenue cycle operations. Of organizations surveyed that had yet to deploy automation, 37% planned to do so within a year11.
To be successful in their outsourcing and automation efforts, there are best practices healthcare organizations should follow to ensure they identify the right partner. Among the attributes to look for are the depth and breadth of the supplier’s experience, which also speaks to the prospect’s ability to fully understand the complexity of federal and state regulations. Other attributes include:
– Dedicated customer service representatives, available 24/7, to act as a liaison and take a proactive approach to the relationship, including coordinating ongoing training, escalating service requests assistance and providing monthly or quarterly activity reviews.
– Versatility and flexibility to accommodate non-traditional staffing hours and needs in today’s healthcare environment to ensure patients have access to the best financial care regardless of unexpected volume increases12.
– A deep bench of highly skilled, college-educated and credentialed coders who are dedicated to a single client and therefore able to work as an extension of the in-house team
– Reputation for providing quality service and meeting service level agreements (SLAs).
Also ask how many charts on average they are able to code per day, week, or month, and what their HIPAA compliance policies and procedures are. Finally, it’s important to ask for — and connect with — references who can speak candidly about the potential partner’s ability to deliver on the promises made during the sales process.
Once the right partner has been selected, it is crucial to establish key performance index (KPI) benchmarks unique to the organization. These may include collection costs, customer account days, or other metrics. KPIs should also go beyond traditional A/R metrics. Cash as a percentage of net revenue is another possibility, as write-offs are a percentage of net revenue. KPIs also help create a relationship based on transparency. Clearly defined goals that can be tangibly measured ensure realistic – and honest – expectations.
The right balance
There is no one-size-fits-all solution when it comes to finding the right balance between technology and service. Instead, the key is taking the time to understand the organization’s unique staffing challenges and the right mix of services and solutions to overcome them.
Look for a partner who will take the time to analyze existing processes to determine areas for improvement. They must be able to assess existing people, processes and technology to create a customized solution of services, technology and support. In doing so, they can amplify current processes that are working well while closing gaps and improving bottom line results.
Finally, recognize that revenue cycle management is not static, which means any outsourced partner must be prepared to change and adjust services and provide on-demand scalability to meet changing needs.
About Cheryl Cruver
Cheryl Cruver is Director of Revenue at AGS Healthcare, an analytics and technology-driven revenue cycle management company that eases the financial and administrative burdens of healthcare providers by providing billing, coding,… automation and analysis. Cheryl has over 20 years of healthcare experience helping providers leverage data and technology to drive cost savings and improve outcomes. In her role at AGS, Cheryl leads the sales and customer service teams in achieving strong and continuous revenue growth and customer success.
Prior to joining AGS, she worked at SONIFI Health, a leading provider of patient engagement solutions for healthcare systems, where she led sales strategy, business development and innovation as Chief income. His experience includes leadership positions with organizations such as Medicity, HDMS, MedVentive, Microsoft, Sentillion, ProxyMed, Healtheon/WebMD and SmithKline Beecham Clinical Laboratories.
1. Gooch, K. Immunization-related employee departures from 55 hospitals, health systems. Becker Hospital Review. February 17, 2022.
2. American Hospital Association. Trend Watch: Strategic Workforce Planning for Hospitals and the Health System. January 2020.
3. US Bureau of Labor Statistics. Specialists in medical records and health information. Career Prospects Handbook. Visited February 20, 2022.
4. Staff. To maintain cash flow in today’s tight job market, revenue cycle leaders are using technology – 3 experts answer 3 questions. Becker Hospital Review. November 16, 2021.
5. Daily payment. Healthcare turnover rate [2021 Update]. Blog. June 14, 2021.
6. George Washington University School of Business. The main costs associated with running a hospital. Blog. July 15, 2021.
7.FQHC. November 14, 2014.
8. Benediction, T. Increasing the functioning of the revenue cycle in a post-COVID world. For registration. June 10, 2021.
9. LaPointe, J. As revenue cycle management grows, automation is essential. Revenue cycle intelligence. September 27, 2021.
10. LaPointe, J. RCM Automation Boosts Practice’s Accounts Receivable Efficiency. Revenue cycle intelligence. March 17, 2021.
11. Akasa press release. Automation of healthcare revenue cycle operations increased from 66% to 78% in less than a year. PR Newswire. August 19, 2021.
12. Medical Data. Provide scalable and patient-focused revenue cycle management services. mfm. August 31, 2021.