Category Archives: RCM Consulting Services

As a leader in Healthcare Revenue Cycle Management Consulting, Nearterm is uniquely positioned to offer insight & solutions to common RCM challenges.

Hospitals Staffing Levels Improve With RCM Solutions

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There’s no doubt that healthcare workers are the backbone of the health service, so it makes sense for a healthcare provider to manage their staffing levels in a strategic manner. Revenue cycle management (RCM) services help hospitals to meet staffing needs while saving money. This cost-effective approach is gaining momentum as healthcare providers strive to offer excellent care while meeting business needs.

The Market Is Changing

Nowadays healthcare workers enjoy the freedom of being able to work flexibly and at different locations, because they don’t like the idea of being tied down to one place. Also, they like to make the most of the opportunities that arise at any given time, because they understand that this will add to their employment portfolio. This model is also beneficial for healthcare providers, as it makes the process of hiring skilled staff easier, and because contract workers often get paid a little more than in-house staff, they don’t have to offer benefit packages.

According to Global Human Capital Trends 2015 series, more than one-third of all workers in the United States are contract workers. What’s more, just over half of all respondents say that their need for contingent workers will continue to grow over the next three to five years as the market shifts toward a more agile workforce.

Contract Workers on Demand

Many firms rely on contract staff to meet supply and demand, but with hospitals, the need for contingent workers is even greater, because they simply can’t afford to be understaffed. Healthcare providers constantly need to meet their patients’ needs so that they can provide a good level of care.

rcm solutions

Nearterm’s 360 Managed Services can help you meet your staffing needs by meeting with you to discuss your requirements. Project staffing involves meeting with one of our experts to ascertain the type of workers you are looking for. This will include skill set, the scope of work, project details, schedule and other related matters. Once this has been established, we gather the resources you need and arrange for them to be there as and when you need them, both on-site and remote.

Revenue Cycle Management Service

RCM services manage a number of business-related tasks so that you can get on with what you do best: caring for your patients. These RCM services include:

  • Situation Analysis — Objective operations assessment to facilitate planning and decision-making processes.
  • Operations Action Plans — The plan of action process is a proprietary service wherein Nearterm leads your organization through a very structured process aimed at establishing targeted change.
  • Implementation Assistance — We deliver the additional ”horsepower” you need when implementing certain planned activities.
  • Organization Development — Our team of professionals serves as the catalyst your organization needs in the development process.
  • Centralization and Decentralization — We specialize in assisting providers with all aspects of centralization and decentralization, from the earliest consideration through the continuum.

In addition to RCM services, we also:

  • Present customized training programs
  • Develop and document policies and procedures
  • Provide conversion assistance
  • Design reporting packages
  • Tailor our services to meet your organization’s specific needs

RCM services help you to plan better so you can deliver top-quality care in this increasingly competitive market.  Hospital finance departments are often under pressure to crunch the numbers and balance the books. But without careful planning, recruiting staff can be more expensive than it should be. If you want to find out more about what we can do for your organization, please get in touch.

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Pygmalion In Revenue Cycle Leadership

The Pygmalion Effect on Revenue Cycle Leadership

The Pygmalion Effect can be described as the phenomenon whereby higher expectations lead to an increase in performance.

Much has been written about the Pygmalion Effect. The concept is controversial. However, like most controversial concepts, there are elements of validity that can be applied successfully in the workplace and particularly in Revenue Cycle Management. Consideration of this idea requires understanding that it is not as simple as arriving to work with high expectations and leaving that night with record performance improvement as a result of your expectations. On the contrary, it is a leader’s behavior expressed to followers over time that can affect the behaviors of followers. The more an employee is engaged in learning activities, the higher the expectation from the leader. In turn, the employee participates in more learning behavior and leaders then tend to gain the level of trust, respect and confidence that leads to process innovation and performance improvement.

By way of illustration, consider this passage from George Bernard Shaw’s play, Pygmalion:

“You see, really and truly, apart from the things anyone can pick up (the dressing and the proper way of speaking, and so on), the difference between a lady and a flower girl is not how she behaves but how she’s treated. I shall always be a flower girl to Professor Higgins because he always treats me as a flower girl and always will; but I know I can be a lady to you because you always treat me as a lady and always will.”

Some managers always treat their subordinates in a way that leads to superior performance. But most managers, like Professor Higgins, unintentionally treat their subordinates in a way that leads to lower performance than they are capable of achieving. The way managers treat their subordinates is subtly influenced by what they expect of them. If managers’ expectations are high, productivity is likely to be excellent. If their expectations are low, productivity is likely to be poor. It is as though there were a law that caused subordinates’ performance to rise or fall to meet managers’ expectations.

Here’s the reveal about how expectations impact people in the workplace:

  • What managers expect of subordinates and the way they treat them largely determine their performance and career progress.
  • A unique characteristic of superior managers is the ability to create high performance expectations that subordinates fulfill.
  • Less effective managers fail to develop similar expectations, and as a consequence, the productivity of their subordinates suffers.
  • Subordinates, more often than not, appear to do what they believe they are expected to do.

If you are interested in this concept and would like to discuss it further, I would welcome your call. Nearterm provides Revenue Cycle thought leadership to a national base of clients, peers and colleagues.

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Use a Cash Acceleration Team to Optimize RCM

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There are many explanations for sluggish cash performance and obviously, understanding causes may be useful in preventing recurrence. Meantime, you have a backlog and the objective is to get caught up. That’s where a Cash Acceleration Team can be helpful.

What is a Cash Acceleration Team? It is a highly customized temporary external resource allocation of seasoned professionals with the right credentials, experience, and skillset to help you get current on your collections and stay there. A team might include Coders, AR Specialists, Billers, Collectors, and Auditors, among others. The size of the team depends mostly on volume, the scope of work and how quickly the organization wants to capture an expressed opportunity but other factors may come into play as the team is customized and designed. Team resources can work remotely or at your facility or some combination.  Successful teams are closely managed and can redirect focus as project demand dictates.

Nearterm can work with you to build just the right team. We’re experts in Revenue Cycle Management (RCM) and our Cash Acceleration Teams are a proven solution for helping your facility achieve its cash collection targets faster and with less effort.

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ICD-10 Changes for 2017 Make RCM Even More Critical

October 2016 brought major changes in the ICD-10, and annual updates to the coding system will be the norm once again.

October 2016 brought major changes in the ICD-10, and the freeze is over. Going forward, annual updates to the coding system will be the norm once again. Keeping up with ICD-10 changes will be an ongoing challenge, making RCM even more critical to maintaining and increasing your profitability.

RCM Challenges

Hospitals and physician practices face a number of challenges in effectively managing the revenue cycle, including:

Patient Access

Patients are becoming more assertive in terms of deciding when and where to receive health services. As a result, health care organizations need to have clear and effective patient access processes in place. New patient registration, insurance verification and accurate billing are more critical than ever before.

Billing and Collection Errors

Billing and collection errors are a large source of lost revenue. This issue is even more critical as the coding schemes change. Improper coding not only delays revenue, but without accurate tracking, payment may never be received.

Collection errors are becoming more common as responsibility for payment changes. Patients are increasingly responsible for more out-of-pocket costs, and insurance providers have a dizzying array of payment levels depending on the policy terms.

Monitoring the Entire Claims Process

It is only possible to catch and correct billing and collection errors when processes are in place to monitor the claims process from beginning to end. Hospitals and physician practices need to invest in technology to track claim metrics and prevent problems.

RCM Action Items

Focus on Staff Training

Every staff member within a health care organization needs to have a working knowledge of patient and insurance payment issues. However, staff members who are directly responsible for managing patient access and coding must understand the importance of the information they deal with.

Getting the right information when a patient is registered lays the groundwork for the entire revenue cycle. In addition, coders need training that will keep them focused on staying accurate even as ICD-10 changes take place.

Establish Clear Patient and Insurance Company Communications

Sensitivity is required to communicate with patients concerning their financial responsibility, but clear upfront communications certainly help. You can pre-register a patient by collecting the information you need to verify their insurance coverage when an appointment is scheduled.

Contact the insurance company to verify the patient’s coverage, and to identify requirements for copayments, coinsurance, deductible amounts and out-of-pocket maximums. Estimate the amount the patient will need to pay and have an open discussion with them about their financial responsibility and the options that are available to them for making payment.

Take Advantage of Technology

Managing the claim process from beginning to end can be a strain on your staff. Use technology wherever possible to improve processing accuracy and reduce the burden on employees.

When you have an automated system in place, be sure to track the critical metrics that will help you troubleshoot your processes and collect all the revenue to which you’re entitled. Important metrics include:

  • Insurance company denials – Track the percentage of denials for each insurance company. Work to reduce these percentages by identifying and fixing problems that are causing denials.
  • Copays collected when service is provided – Once they leave your facility, the odds of collecting from patients go down precipitously. Accurately estimate patient responsibility and work with patients to process payment at the time of service.
  • Collection as a percentage of gross charges – Tracking collection ratios for both patient and insurance company billing will let you know where there are opportunities for improvement.

Operations may be getting easier now that the major updates to ICD-10 have been made, but ongoing changes are inevitable. The time is right to review your revenue cycle management systems to ensure that you’re on the right track moving forward.

If you have questions, we’re here to help. Feel free to get quick answers by submitting your question to Ask the Experts.

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