Streamlining Operations: One Way to Prevent Denials
We have all heard the saying “too many cooks in the kitchen spoil the broth.” Well, same rings true for healthcare and the revenue cycle. Too many people involved in managing a task, such as obtaining authorizations, can hinder success and lead to denials. These are denials that could have been avoided if everyone involved was on the same page and following the same process. This is where streamlining operations comes into play. Establishing a single oversight, centralizing revenue cycle functions, and standardizing processes are the steps to streamlining operations.
Establishing a Single Oversight
The reporting structure for revenue cycle operations differs from hospital to hospital. Some report to the CFO, some report to Quality/Case Management, some report to IT, you name it. There seems to be no rhyme or reason, but “who” the revenue cycle reports to does matter. It really matters when what happens in revenue cycle directly impacts a hospital’s cash flow. Establishing a single oversight with the knowledge of all revenue cycle operations allows hospitals to focus on the tasks needed to minimize denials and maximize reimbursement. Revenue cycle needs one cook in the kitchen!
Centralize Revenue Cycle Functions
With a single oversight, the next step is to centralize revenue cycle operations that can be centralized such as all pre-arrival services (scheduling, authorizations, notifications, pre-registration, and financial clearance). Centralizing these functions fosters a team environment by putting, side by side, the functions that depend on each other. This synergy not only increases productivity, but also improves team morale. Economies of scale can also be realized from centralization, providing the opportunity to cross train, reallocate, or reduce staff depending on the hospital’s situation. Having all pre-arrival revenue cycle functions in one place allows for easier management and increased accountability with the focus on denial prevention.
Once revenue cycle operations are centralized, it is time to evaluate all workflow processes and identify opportunities for standardization. Defining a standard process for each task within the revenue cycle reduces the risk of denials caused by everyone on the team doing things their own way. When everyone on the team is following the same process, it is much easier to perform quality assurance checks, identify errors, and fix the errors prior to billing for denial prevention. Just like having too many cooks in the kitchen spoils the broth, having too many ways to perform the same task increases the risk for error. Create a unified, lean approach to accomplishing all tasks and stick with it.
Streamlining operations within the revenue cycle is just one strategy for tackling denials. Having a one oversight, one location for all pre-arrival services, and one way of performing each task will enable everyone involved to remained focused on preventing, overturning, and eliminating denials. Here’s to the power of one!
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