Improving patient outcomes and reducing denials are among the primary goals of all healthcare organizations; what both of these goals have in common is that they can both be achieved through a clinically driven revenue cycle. Integrating clinical data into claims processing will significantly reduce denials, leading to fewer days in accounts receivable and, ultimately, higher collections.

As opposed to a more traditional revenue cycle management process, a clinically driven approach is all-inclusive; it focuses on patient care throughout the entire healthcare process. Not only is such an approach beneficial to the organization, it also yields a higher quality of care for patients by ensuring that care standards are kept high at every step of the process, in order to maximize revenue. Combining clinical expertise with RCM in this manner allows for better decision making, as clinical data will be used to make informed and proactive decisions in identifying and rectifying any problems that may arise in the claim submission process.

Implementation

Keeping in mind the holistic nature of this approach, it should come as no surprise that implementation is not as simple as flipping a switch. It involves changing the way care is delivered at an organizational level, as well a few adjustments to organizational culture.

Organizational Culture: The first step to successfully implementing a clinically driven approach is to ensure that all members of staff are fully on board with the change; this includes physicians, nurses, clinical and administrative staff. The entire team needs to working together to ensure that patients are being provided a high standard of care, while maximizing revenue.

Technology: Technology is a core pillar of any healthcare business; the training required to properly use said technology is crucial to task automation, improved communication and coordination, and gaining real-time insight into key performance indicators.

Processes: To ensure uniformity in how staff members perform the procedures and protocols relevant to the new approach, it is essential to develop standardized processes, and to properly train staff in how these processes are to be carried out.

Benefits

As stated above, a clinically driven revenue cycle is not a simple plug and play solution that solve all of the problems an organization is having with its revenue cycle. Rather, it is an ongoing change to the way the revenue cycle is managed, and as such it should be regularly evaluated in order to ensure the organization remains aligned with clinical best practices.

Improved Patient Care: A focus on patient care throughout the process ensures that patients are delivered high quality, coordinated care at every step of the process; this improves the patient experience and outcomes, and is more efficient for the organization. As this process improves care and removes unnecessary complications, patients receive better care, and they receive it quicker. Patient-centric approaches like this one improve overall patient satisfaction levels, leading to higher collections, as well as referral and retention rates.

Greater Efficiency: By streamlining care delivery processes and eliminating redundancies, patient care is improved. Documentation time is also shortened; the ability to document clinical actions in a clear and concise fashion will improve communication among staff, leading to improved patient outcomes. Reports generated in real-time provide better insights into key performance indicators, leading to better and more informed clinical decision making.

Boost Revenue: Improvements in care delivery will naturally translate to improvements in revenue; with patients receiving better and more efficient treatment, retention and referral rates will start to increase. In addition, a lower rate of claim denials will also give organizations greater breathing room in terms of reinvesting into the business in order to grow.

Fewer Denials: Once all aspects of the revenue cycle are aligned with clinical best practice, organizations will see fewer denials coming their way.

Lower Costs: Automation in repetitive tasks will allow organizations to spend less time and money on activities that add little to no value. Staff will have more time to focus on activities related to patient care.