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Practice management knowledge hub

Is your practice running as efficiently as possible? Discover tips and insights that can help streamline your practice management.

Revenue cycle management and reporting for larger organizations

At larger health systems, revenue cycle management is becoming increasingly complicated. The transition from the fee-for-service model to an enormous variety of risk-based and shared-savings models is both complex and unsettling, because it is unclear which model – or which combination of models – will ultimately dominate. Further complicating revenue cycle management is that many health organizations are transitioning into being part of an Accountable Care Organization (ACO), in which caregivers are rewarded for both quality and value, rather than volume.

The interdependence that characterizes these models requires larger health organizations to develop network strategies that address the entire continuum of care: Identifying and targeting patient populations, achieving clinical integration across their network, and leveraging data from anywhere and everywhere across their care community.

For effective revenue cycle management, to achieve both revenue and outcome goals, these organizations need actionable insight into the financial performance of their group and the health of their patient population. With visibility across their network that can be influenced and acted upon at the point of care, the goals of these larger health systems are achievable.

To gain this actionable insight, health systems need tools that can deliver it, and help them manage their networks and patient populations, no matter what the payment model might be. A traditional data warehouse or static health information exchange (HIE) can’t deliver this insight. What is required is an application that harmonizes data from multiple systems (EHR, practice management, claims) and turns it into insight which can then become action directly in an organization’s existing workflows. By converting information into action, organizations can align providers to achieve clinical and financial integration.

As part of this overall strategy, revenue cycle management applications should provide features such as:
  • Consolidated network revenue cycle and productivity data
  • Analytical tools that display information clearly and accessibly
  • Actionable insight into collections, referrals, denials, DAR, etc.
  • The ability to easily “slice and dice” data and share performance results
  • KPI data filtered by location, department, or role
  • Benchmark tracking and performance comparison by practice, specialty, or geography

As larger health organizations transition to new models of reimbursement, they need tools that are nimble enough to keep pace with industry changes — tools that enable them to achieve both effective revenue cycle management and quality patient care.

 

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