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Effective Revenue Cycle and Compliance Management for Maximizing Revenue & Valuation

  • Vicki DiFrancesco

Revenue cycle management (RCM) and its supporting business intelligence (BI) are critical to an organization’s success, from a compliance as well as a revenue and valuation maximization perspective. Efficiency and effectiveness of a lab’s RCM processes are among the fastest routes to financial improvement and successful navigation of regulatory challenges. Five essential capabilities contribute to optimized RCM:

  • Financial Integrity: Timely and accurate financial data is required for compliant billing and essential to understanding business performance. Detailed financial reports provide the information necessary to improve decision-making, enhance contracting, and identify areas that may benefit from process optimization
  • Visibility: Make crucial business decisions based on actionable analytics, including key performance indicators and peer-to-peer benchmarks.
  • Intelligent Automation to Optimize Workflow: Ensure upfront, clean, and trackable claim submissions in the shortest possible time, and automate appeals and other follow on activity rather than letting claims languish unpaid in “hold” queues.
  • Connectivity: Support bidirectional data exchanges in real time, ensuring a smooth path to fast reimbursement and eradication of data latency errors that plague most financial reporting.
  • Compliance: Ensure that regulatory and legal billing practices are consistently followed, reduce clerical decision making, remove hard-coded policies that may no longer be compliant, and eliminate errors in mandatory reporting, which can otherwise result in substantial fines.

Laboratories also need trusted, accurate financial data to track trends and metrics over time. This data needs to be fully auditable and built upon a healthcare technology system with underlying financial integrity. It is also important to be able to access BI without impacting production system performance. 

Key BI components and capabilities include:

  • Dashboards - View information summaries with ease and drill down for further detail if necessary; no need to expend large efforts to get the info needed to measure important KPIs.
  • Compliance - Ensure data integrity, be audit ready and GAAP/SOX (Sarbanes-Oxley) Compliant. Address PAMA and FASB 606 accounting requirements readily.
  • Benchmarking – Have ready access to the metrics that enable you to track and compare your financial and operational performance to your industry peer group.
  • Key Performance Indicators (KPIs) - Understand trends and establish and track KPIs to continue to improve collections practices year after year.
  • Streamline Operations - Run reports without impacting production system performance and reduce dependency on IT resources to generate reporting.
  • Drill-Through Data - View contextual details related to the data elements by drilling up or drilling down in the summary reports.
  • Ad Hoc Reporting - Enable users to easily build and save their own reports without IT support.

“How well a lab manages RCM processes, workflows, and tools will determine its ability to capture all potential revenue and increase its profitability, and ultimately its valuation.” 

Robert L. Michel
Editor-in-Chief, The Dark Report

Download this recently released White Paper, “The Laboratory Executive’s Guide to Maximizing Revenue & Valuation: Effective Revenue Cycle and Compliance Management are Critical Success Factors,” to learn more on how laboratory and pathology groups can improve their revenue cycle management capabilities to survive and thrive in the current healthcare market. The paper argues that despite its complex nature, optimizing laboratory reimbursement remains, for many labs, the best mechanism for improving financial performance. 


Published by XIFIN
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