Optimizing revenue cycle management is at the top of the list for nearly every healthcare organization. Increasing patient collections, reducing the number and amount of overdue patient balances, streamlining administrative costs, and modernizing the overall patient financial experience are all big priorities that impact the health (no pun intended) of the entire organization.
On the surface, revenue cycle management may seem to only involve making financial decisions. But as the role of the revenue cycle leader continues to evolve, it now also involves making important technology decisions to help support the business.
In our work with leading healthcare organizations, we see CFOs and finance leaders partnering with their CIOs on decisions about optimizing the many processes around revenue cycle management. Their collaboration typically focuses on five core areas, which we’ll review at a high level.
1. System integration
Healthcare IT environments are very complex. The most effective payment solutions integrate with existing systems and workflows to create efficiencies for both the hospital and the patient. Not bringing IT into decisions around revenue cycle management technology early enough can create a lot of extra work and complexity for the CIO and the IT team. Integration can also impact regulatory and compliance requirements like HIPAA that have to be met.
A lot of the hard stuff in revenue cycle management happens on the backend, which requires surfacing data from the EHR and finance systems and ensuring that these systems can talk to each other. For payment solutions to work in healthcare, they need to provide more than payment processing; they need to integrate into existing systems and workflow to create efficiencies for both the hospital and the patient – in a secure way that ensures compliance mandates are met. Enabling a pleasant payment experience alone is not enough. If the systems of record can’t share the data back and forth, it doesn’t really solve the problem.
2. Best-of-breed vs. single system
EHR is a massive investment and it’s understandable that CIOs often want to consolidate around a single system or vendor to eliminate those integration challenges mentioned above. But that doesn’t always lead to simplification for IT or improvements in the patient financial experience. For example, some EHR vendors are presenting product roadmaps with aggressive plans for revenue cycle management capabilities. An EHR-first strategy for all revenue cycle management functionality may involve tradeoffs in the patient financial experience – as well as take time from your IT staff.
One of the major considerations when exploring third-party revenue cycle management solutions should be robust, out-of-the-box integration capabilities with your existing EHR. There is no need to make the tradeoffs required with a single consolidated solution. Taking advantage of the advanced capabilities in best-of-breed revenue cycle solutions will do far more to advance the business goals of your healthcare organization.
3. Staffing requirements
You and your CIO are likely both facing staffing shortages. So, taking on new projects around revenue cycle management that carry important technology considerations – as outlined above – may seem fraught with challenges. The question to ask is how much time both your team and the IT team spend around the revenue cycle management process that could instead be spent on more value-added tasks.
Automating more of your revenue cycle management processes not only frees finance staff to focus on higher-value activities, it frees IT from having to configure or customize the required functionality within the platform. Both sides benefit from addressing other important business goals such as revenue collection and patient satisfaction. A solution that integrates easily with your existing systems will eliminate a lot of the IT staff requirements that might be anticipated.
4. Cybersecurity and compliance
As the cost and risk of data breaches increase, security and compliance continue to rise in importance across the executive suite. In addition to HIPAA compliance, PCI Level 1and SOC 1 certifications, there are also questions about new topics like Advanced Encryption Standards (AES), the encryption standard selected by the National Institute of Standards and Technology (NIST) for securing sensitive unclassified information. You and your CIO will both want to know how data is encrypted in any revenue cycle management solution.
More healthcare organizations are taking a cross-functional approach to payment security to make sure they are covered from every possible angle.
5. Business strategy
Effective revenue cycle management processes are the crucial touchpoint between patients and providers, and a key driver of the healthcare organization’s financial health. A confusing or frustrating payment experience negatively impacts patient satisfaction, loyalty, and the healthcare organization's overall financial performance. All the decisions above have to be made in the context of what’s right for your healthcare organization and the business. Is the decision you and your CIO make regarding revenue cycle management going to truly modernize the patient financial experience, or simply make an incremental improvement that needs to be revisited in two years? Are you building a foundation for the future of the business, or a temporary fix? Will it truly improve revenue collections, reduce bad debt, and streamline administrative requirements and costs for both finance and IT? Strong collaboration between CFOs and CIOs can ensure that healthcare organizations are making the right decision for both the short and long term. This will help accelerate innovation and help providers enhance the patient financial experience to both improve patient outcomes and organizational business results.