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RCM: Fixing the Old and Adjusting to the New

By Grayson Miller

JULY 11, 2023 – Revenue Cycle Management (RCM) is like a one of those huge Lego sculptures. From the outside it looks one thing, but upon further inspection there are a million tiny little pieces that fit together to create the whole. Having a well executed RCM strategy is crucial to keep your organization running because it impacts everything. When things are simple and easy to pay for, patients are happy, the staff is happy, and you are most definitely happy. But if any part is misaligned, the whole sculpture can be disformed or even fall apart. So how do we improve? How do we make our sculpture be more realistic? The key lies in optimization. We need to be looking for areas that we can simplify to make everyone’s life easier.

But equally important to keep in mind as we optimize our RCM sculpture, as we optimize old practices, we need to prepare to adjust to the new changes. For example, for Legos any curves needed to be built using rectangles, because that was all that was available. To simplify this, Lego found ways to create arched pieces. But in optimizing the process, the old instruction manuals were now outdated and adjustments needed to be made.

To better understand ways that RCM can be optimized and how to best prepare for any needed adjustments, we reached out to our incredibly talented Healthcare IT Today Community for their insights. Below is what they had to share on this topic!

Brooke LeVasseur, CEO at AristaMD

Value-based care shifts the focus of RCM strategies from charge capture to utilization. These models require providers to eliminate: Fragmented care that drives up costs. Requests for unnecessary or duplicate imaging lab work and tests. Delayed care that delivers poor outcomes for the patient. Technology can help. Referral management tools verify insurance, identify in-network specialists, and improve care coordination. Physician-to-physician consultations – or eConsults – enable primary care physicians to quickly treat lower acuity issues themselves. That means less care fragmentation, fewer unnecessary tests and faster diagnosis and treatment.

In an environment where specialists are in short supply, these tools prioritize face-to-face referrals while offering specialty care advice in the primary care setting. RCM data can identify areas where errors are made, like referring to an out-of-network specialist and opportunities to lower expenses, like accessing electronic consultations. PCPs can eliminate errors by verifying insurance before referring a patient, identifying in-network specialists and transferring patient information to avoid duplicate imaging and lab work – keeping costs low for the patient and the overall healthcare system. PCPs can lower costs and improve outcomes by leveraging eConsults to expedite specialty care access without the time and expense of referring the patient.

Read what other experts in the field have to say about RCM.

Healthcare Trends: Will Reduced Manual Processes & Retail Expansion Impact RCM?

RCM healthcare trends

Our predictions for 2023 healthcare trends focus on reducing manual processes to improve staff retention and patient satisfaction. ​In addition, we also expect a greater expansion of retail primary care, which will require greater coordination of data. This year may finally deliver interoperability as retail clinics and patients demand less bureaucracy and faster diagnosis and treatment.

Focus on Data and Efficiency to Reduce Patient and Staff Burdens

As we discussed in our last blog, Referral strategies for specialty care clinics that reduce administrative work, medical practices do not have the staff to support inefficient processes that create more work for the practice and the patient. Moves toward greater efficiency will take the lead in 2023. Healthcare organizations will:

1. Increase patient engagement and improve the patient experience by adding more tools that reduce the need to verify insurance coverage, copays and prior authorization requirements.

  • The AristaMD platform already offers insurance verification to those practices using its referral management service. The solution also indicates whether a specialist is in-network and nearby.
  • eConsults services will continue to improve patient satisfaction by eliminating the need to visit a specialist to receive specialized diagnosis and treatment advice. eConsults allow PCPs to access recommendations from specialists in more than 70 specialties and subspecialties within hours.