Healthcare has changed tremendously over the past decade. From increasingly complex payer requirements to growing federal and state regulations to a substantial change in the payer mix (patients are now the second largest payer (27%) behind the federal government (34%), which is mostly Medicare and Medicaid). Today’s revenue cycle is an entirely new animal. What used to be a reasonably straightforward revenue cycle process — see the patient, code the claim, get paid — is long gone. And those who lead the charge are under more significant pressure from hospital leadership, who now recognize revenue cycle management executives’ increasingly vital role in their organization’s financial success.
The following are five skills an ideal revenue cycle leader needs to drive financial prosperity in a post-pandemic ecosystem.
1. Understands the patient experience
According to the Beryl Institute and HFMA, “Revenue cycle is far more than an operational function: it is a strategic drive that frames the patient journey, as it is typically the first impression and the last touchpoint with a healthcare organization.” Our current revenue cycle was built around payer and provider processes, but that model is outdated and inefficient for today’s new reality. We now realize that the back office of healthcare is broken regarding the patient experience. Issues like slow prior authorizations, inaccurate eligibility information and problems with medical necessity and timely filing all negatively impact the patient’s ability to receive timely access to care.
This is why it is critical that revenue cycle leaders have a deep understanding of every step of the patient experience, from prescheduling to payments and billing. This insight should inform every decision they make and have them constantly asking, “How does this impact the patient?” This should be the motto of the entire revenue cycle team and one regularly emphasized by revenue cycle leaders.
2. Embraces innovation, automation and new technologies
New technology like artificial intelligence (AI), machine learning (ML), and robotic process automation (RPA) have led to greater innovation in healthcare, especially in workflows related to the revenue cycle. Eligibility verification is a great example. Staff typically spends hours on the phone or payer websites looking for eligibility information. By automating the eligibility verification process, these technologies help reduce rejected and denied claims while enabling staff to be assigned to more strategic initiatives.
Another area where technology can help improve revenue cycle workflows is coding — a process that can lead to significant stopped cogs in the revenue cycle and lost revenue potential. Automation technology can detect and flag potential coding errors so the claim can be corrected before ever having a chance to be denied.
Leveraging innovative new technologies to identify and resolve potential issues proactively will become a key differentiator in provider organizations with healthy revenue cycles — especially in a time of increasing denials, Medicaid unwinding and payer takebacks.
3. Dedicated to a culture of communication and collaboration
Revenue cycle staff must understand that just because they work in the back office doesn’t mean their roles are isolated or insignificant. This is one of the essential concepts today’s revenue cycle leaders need to get across to their teams. Every person, from the scheduler to the coder to the biller to the collector, must understand how their work’s quality impacts the patient, the team, and the organization’s success. They need to feel as though they are a vital part of a larger ecosystem that ultimately enables better outcomes — because they are.
This requires revenue cycle leaders to be excellent communicators and empathetic listeners. This is no small feat considering how many “back office” jobs are now remote. It takes extraordinary effort to ensure every remote team member gets the same attention as those onsite. Revenue cycle leaders need a comprehensive plan to develop and maintain personal relationships with each person. Video conferencing can help create a more personable encounter, while virtual team activities can promote camaraderie and a sense of belonging.
4. Empowers success
Revenue cycle workers, especially those with the most experience, are in high demand and short supply. Now that so many of these roles are remote, these employees have more options than ever for finding the perfect job. Because they’re no longer tethered by location, they have a greater pool of options to pull from. This has also made attracting and retaining these employees more challenging. Smaller hospitals and health systems, particularly, can find it difficult to compete with the high salaries, advanced benefits,and sign-on bonuses larger organizations can offer.
In light of this new reality, today’s revenue cycle leaders need to work closely with their human resources team to develop job advancement and mentorship opportunities for employees. Leaders should make a concerted effort not to fall into the “out of sight, out of mind” trap. Instead, leaders should talk with remote employees about their career goals, their strengths and areas where they want to improve. This could mean offering incentives for furthering education or certifications, as well as developing personal KPIs and scorecards. And it is important to remember to celebrate success — small and large.
5. Adapts to change
Perhaps one of the most critical skill-sets today’s revenue cycle leaders need is the ability to adapt to change. This is something our industry experienced recently with the COVID-19 pandemic. With the onset of the pandemic, providers had to quickly pivot to telehealth, workers had to adjust to working from home and healthcare leaders had to learn to be creative in the face of equipment and supply shortages.
Because so much has changed over the past three years, most of us still live with unease and uncertainty. Will telehealth continue to be popular with patients? Will remote workers ever come back to the office? Will margins ever rebound to pre-pandemic levels? There is no way to know with certainty the answer to these questions.
What we do know, however, is that healthcare is a complex, ever-changing industry—even without a pandemic. But resisting change, according to the Center for Creative Leadership, is one of the top reasons for career derailment. Conversely, by embracing change, leaders are more able to identify new opportunities and more likely to be innovative in finding new ways — better ways — of doing things.
The path forward
Yesterday’s revenue cycle consisted of back-office workflows built primarily around payer reimbursement. This is no longer the case. Today’s revenue cycle is all about the patient experience, timely access to care, reducing costs and improving efficiencies. To be successful in our journey forward, our industry needs revenue cycle leaders who are instruments of change, working to create a better healthcare ecosystem focused on the patient.