RCM Services and Outsourcing: A Quick Win to Mitigate Staffing Shortages

In its annual survey, the American College of Healthcare Executives (ACHE) asked community hospital CEOs to rank the top issues facing their organizations. Workforce challenges (including staffing shortages) ranked as the number-one concern for the second consecutive year. Financial challenges ranked second for the third year in a row. Ninety-four percent of responding CEOs reported rising costs (including staffing costs) as the primary financial issue. As seen in the table below, other top issues related to financial challenges involved reimbursement and controlling costs.

And these two concerns heavily impact one another. After all, with a smaller pool of qualified clinicians and support staff available to recruit, attracting and retaining talent costs more. If your organization is under financial strain, you may not have the resources to fill open positions.

These issues, however, aren’t unique to community hospitals. In a recent Experian Health survey, all of the 200 surveyed revenue cycle executives agreed that “staffing shortages significantly affect reimbursement workflows to the detriment of patients and healthcare employees.” The bottom line is that hospitals continue to face elevated pressure to address staffing shortages—while navigating rising FTE salaries and ensuring reimbursement for services provided.

The Pathway to Relief: Optimizing Revenue Cycle Management

Optimizing the revenue cycle, even on a departmental level, carries the dual benefit of alleviating staffing and financial pressures. Finding new efficiencies and accelerating time to reimbursement provides a clear financial payoff. Well-oiled RCM processes and workflows can help hospitals and health systems:

• Increase clean claim rates with systematic eligibility verification, patient demographic and insurance discovery, and prior authorization support.
• Reduce back-end denials, ensuring reimbursement for services.
• Speed reimbursement through automation, especially for repetitive tasks and subprocesses.
• Identify ongoing opportunities for improvement by incorporating AI-enabled analytics and financial reporting.
• Improve customer service and the patient experience.

You can use these cost savings and increased reimbursements to help address staffing shortages, reallocating dollars toward recruitment, retraining, and salaries to attract and retain personnel.

Outsourcing Ancillary and Outpatient RCM: Accelerating ROI

For a hospital, let alone a more extensive health system or IDN, overhauling the entire RCM process is complex and time-consuming, involving a vast array of stakeholders, care venues, encounter types, and systems. On one end of the clinical spectrum, you have a multi-day acute event that can transition from the emergency department to surgery to the ICU, along with the diagnostic and therapeutic care haloing the patient. On the other, you have outpatient events as seemingly simple as a lipid panel or chest X-ray.

So, start there with small but meaningful improvements in the outpatient revenue cycle. Although most hospitals have an enterprise EHR with embedded or complementary RCM capabilities, those systems are typically optimized for acute care. When it comes to outpatient and ancillary services—such as radiology, pathology, and clinical lab work—there can be gaps and opportunities for RCM efficiencies. If your hospital lab performs outreach services, a purpose-built solution can yield even greater benefits because it can heighten customer service and streamline communication among providers.

Scrutinize your billing processes through the lens of a claim’s lifecycle. High-volume, lower-cost procedures can especially benefit from revenue cycle automation. Look for a partner with dedicated knowledge of those ancillary and outpatient settings, which can help unearth new efficiencies and accelerate ROI. XiFin data indicate organizations with a purpose-built RCM solution for outpatient and outreach billing realize a 10% to 30% boost in cash collections.

Outsourced billing and revenue cycle management can provide additional opportunities. In today’s difficult financial climate, where hospitals need to be exceptionally agile and adaptive, outsourcing all or part of the outpatient and ancillary services RCM process allows you to delegate the high-volume, lower-value work—along with the pain of keeping up with changing regulations and payor requirements. It also complements your team with a knowledgeable companion resource, which is especially important when locating the appropriate skillset or expertise within their community proves challenging. It opens the opportunity to reallocate staff to more complex, higher-value, patient-facing work. And if your hospital’s financial needs are especially urgent, it provides the speediest path to ROI.

Conclusion

Staffing and financial challenges present a potent one-two punch for hospitals to navigate. Improving your hospital’s RCM processes helps mitigate both. There are several paths to quick wins. Outsourced billing services can help augment your team, while realizing billing and process efficiencies, accelerating cash flow, mitigating staffing challenges, and improving margins. It also increases cash collections, creates better patient experiences and physician engagement, improves claims management, and optimizes workflows.

Friction in the outpatient financial experience can undermine trust in your hospital. But there are tangible steps you can take to transform that friction into affinity. For five examples how, view our on-demand webinar, conducted in partnership with HFMA.