Revenue Cycle Solutions
RCM
Provider revenue cycle is a complex process. There are a lot of moving parts e.g., reimbursement models, codes, coding rules, payor contracts, compliance rules, changing insurance plans. The process itself is highly dependent on continuous manual steps in the context of highly sensitive clinical setting.
- Providers spend between 2%-10% on the cost of revenue cycle depending upon the type of providers and the efficacy of the revenue Cyle.
- Although the cost is important, the realized yield on gross revenue is even more important when it comes to provider net revenue.
- Coding compliance and correct coding can significantly impact net revenue. The process being highly manual is prone to errors.
- Value Based reimbursement models are forming a greater share of provider revenue and traditional RCM solutions aren not designed to adequately address these new models.
RCM Trends
Over the last few years, providers have deployed a variety of approaches to keep afloat in the context of increasing complexity and tight labor market while reimbursements have remained constant.
- Outsourcing has gained momentum.
- Offshore outsourcing has rapidly grown, especially due to tight labor market.
- Robotic process automation has gained even more popularity to improve labor efficiency.
- Promise of cloud-based AI driven services have created a huge investment in this infrastructure, but with little impact.
Today's provider revenue cycle relies on outsourcing to labor cost, but does it improve bottom line?
RCM Challenges
While a push for greater technology and outsourcing has a promise of reduced cost and greater revenue, it often creates a lack of transparency and erosion of provider expertise to manage NET revenue. The focus can shift to the management of the process and away from leakage, yield, coding and billing and most importantly understanding and negotiating contracts and evolving reimbursement model.
- Fragmented process and lack of transparency
- Misalignment of incentive can create conflicting priorities between the vendors and providers
- Technology and analytics have a great potential, but leveraging these tools requires expertise to uncover potential opportunities
- Value based reimbursement models are forming a greater share of reimbursement
- Reduced internal skills and capacity
Dynamic nature of today's revenue cycle requires an agile response with precise focus on leakages.
Our RCM Solution
Ingenio Revenue Cycle Solution is data driven and uses the value map as its principal basis. We believe there are opportunity to increase NET revenue by 3%-8% by optimizing the existing processes with Ai while while reducing cost by 10%
1. We utilize our data driven approach to -
- Quantify leakages and their root cause.
- Identify opportunities for improvement.
- Identify opportunities for cost takeout.
2. We use the diagnostics above to create a program -
- Develop point solutions to stop leakage through process optimization.
- Develop strategies to capture additional revenue through FFS and value-based reimbursements.
- Optimize labor and non-labor cost optimization plan.
- Develop an approach to drive vendor programs in place.
3. We drive implementation and manage ongoing performance -
- Ensure point solutions drive expected outcomes and refine them as necessary.
- Guide performance of Value-Based programs and reimbursements
- Monitor cost take out initiatives.
- Monitor vendor performance.
We can help you drive bottom line results of 5-10% in net revenue, while reducing the cost.
