Revenue Cycle Optimization

The Situation

Hospital executives and finance teams are struggling to improve the financial health of their organizations and are constantly evaluating strategies to improve cash flow and grow organizational value. Given today’s healthcare environment, striving for higher margin services is not necessarily the right answer. And cutting expenses can backfire as the quality of services may suffer. One area of focus is internal performance, such as revenue cycle management. How much revenue are you leaving on the table as multiple days of inefficient processes, denials, and rejections, drag on and prevent appropriate and timely reimbursement? healthcare executives must ensure efficient and accurate work flow from pre-registration to back-end denial management, and everything in between, in order to employ effective reimbursement strategies.

A sample application highlights key financial metrics and variance from targets. Alerts and low-performing payers are easily spotted, and data in the dashboard is interactive for root cause analysis.

What is Needed Now?

Executives require increased visibility to the barriers that prevent timely reimbursement and cash collections. Optimizing patient access functions, billing processes and business office operations can only be achieved with advanced analytical applications that provide executives and managers with the ability to effectively address these barriers. It is not enough to have a revenue cycle application that automates some of the processing. To optimize performance, you need a complete view of the end-to-end flow across the entire process. You need to understand where things are getting hung up. Which payers are handling which things differently, and how to eliminate up-stream issues to avoid getting stuck correcting things after the fact? Given the large teams of people working on coding and billing, how do you know who is working on the right things, setting the right priorities, adapting to circumstances in a timely manner? How do the directors and managers know the answers to those questions? Or do you assume that the “squeaky wheel gets the grease” is the right strategy to optimize your receivables?

Executives must understand where problems exist before they can establish action plans to optimize their revenue cycles. They require detailed analysis of variances, payer performance, reimbursement shifts, cycle times, claims management and other revenue cycle components. And they need visibility to payer contract compliance in order to project expected payment and secure appropriate reimbursement.

The WhiteCloud Solution

The WhiteCloud Revenue Cycle Optimization solution provides timely insight into the core processes and payer performance issues that result in suboptimal cash flow and aging account receivables. Based on the WhiteCloud Performance Analytics™ methodology, our solution alleviates the labor intensive, tedious and often error-prone manual processes used by many hospitals today to diagnose revenue cycle problems. Given the fact that healthcare systems automate much of the clerical processing involved in their revenue cycle, why are they then manually reporting, managing, and attempting to optimize its performance? Our solution gives healthcare executives visibility to root causes and drivers of poor revenue cycle management – while at the same time illuminating the insights needed to enhance the organization's financial performance.

• Workflow Analysis
• Improved Cycle Time
• Payer Performance
• Denial Management
• Contract Compliance

The Result:

Better performance and management of revenue cycle, such as improved cycle times, better surveillance of payer performance, and appropriate contract management can lead to increased cash flow, reduced AR days, and overall improvement of financials. Reducing the complexity of revenue cycle data and compiling information into a user-friendly, automated application greatly enhances the efforts of performance management strategies and improves financial outcomes.

• Business office managers have the visibility they need into the drivers of increased AR days, as well as the ability to focus efforts on areas where they will make the biggest impact.
• Payer scorecards provide detailed analysis of the contractual adjustments and denial processes to monitor compliance, allowing your teams to monitor and stay on top of the payers’ latest changes in denials and write down schemes.
• Finance teams are able to focus their attention on specific revenue cycle processes that need improvement to drive AR days down and increase cash flow.