Availity Blog

Healthcare providers are in the middle of enormous change. Declining reimbursement, the transition from fee-for-service to value-based payment models, and consumerism are all influencing the way providers get paid, how much they get paid—even whether they get paid at all. While it’s difficult to stop in the middle of managing these changes to evaluate existing revenue cycle processes, it’s an important step in ensuring your organization is positioned for success.

In Availity’s new ebook, 7 Strategies to Transform Your Revenue Cycle, we look at opportunities for healthcare providers to improve financial performance and increase patient engagement. Below are the highlights:

  1. Track yield as a metric: While many healthcare providers focus on KPIs like “days in A/R” and “cash as a percentage of the cash target,” tracking yield (calculated as cash collected ÷ net expected reimbursement) provides a better indicator of how revenue cycle processes are contributing to the overall financial performance of your organization.
  2. Address the root cause of denials: According to Advisory Board, 67 percent of denials are recoverable and 90 percent are preventable. Get to the root cause and fix them by focusing on where, why, and how.
  3. Focus on upfront processes: Many denials can be tracked back to the patient access processes. Look for ways to improve the front of the revenue cycle by focusing on admission and registration, eligibility and benefits, pre-authorization and point-of-service collections.
  4. Integrate and automate systems: Many hospitals and physician practices are struggling with data silos. Look for ways to break down them down and integrate clinical and financial data across the continuum of care.
  5. Educate and engage patients: A recent study found that only 14 percent of respondents accurately understood the concepts of deductible, copay, co-insurance, and out-of-pocket maximum. Helping patients understand what they owe and why can help improve collections.
  6. Collect more upfront: Collecting at the point of service hasn’t always been a priority for healthcare providers, but with the percentage of patient responsibility increasing, it’s taken on a new sense of urgency. To be successful, you must have the right policies and programs in place, and making sure employees have the resources they need can
  7. Commit to ongoing training: New revenue cycle initiatives—whether that includes new technology, reengineered workflows, or new programs—must be accompanied by robust training and educational programs. Making sure staff has the skills necessary to perform critical tasks is key to a successful program.