Healthcare providers today are facing challenges that range from staffing shortages and disjointed operations to rising costs and frequent claim denials. By breaking down the silos between clinical and revenue cycle teams, healthcare organizations can significantly enhance efficiency and improve financial stability, ultimately leading to improving the quality of patient care.
Addressing Inefficiencies and Rising Costs
Clinicians burdened with administrative tasks—such as documentation and prior authorizations—spend less time focused on their patients. It is estimated that between 15 to 30 percent of U.S. healthcare spending is consumed by clinical administrative services. These include efforts related to clinical documentation integrity (CDI), utilization management (UM), and prior authorizations, a substantial portion of which is considered waste due to manual processes, outdated technology, and miscommunication between departments. Ineffective CDI programs, for instance, can lead to over-coding or under-coding, impacting reimbursement, exacerbating clinician burnout, and negatively affecting patient care. Additionally, physicians spend an average of 14 hours per week navigating prior authorizations, leading to burnout and delays.
A Call for Collaboration
Uniting clinical teams with administrative services—CDI, UM, and denials management—can streamline workflows, reduce manual errors, and improve revenue capture. Better alignment with Health Information Management (HIM) and revenue cycle management (RCM) teams can help ensure that the care provided is accurately documented to better facilitate patient billing and hospital reimbursement. A collaborative approach also fosters a cross-functional, team-based method to increase efficiency and improve outcomes.
The Role of Technology and Strategic Partnerships
Technology serves as a critical factor in this integration process, with artificial intelligence (AI) and automation revolutionizing how healthcare organizations can tackle challenges. AI-powered tools and process automation not only improve accuracy and reduce denials but also eliminate care and reimbursement delays, alleviating strain on staff and resources and reducing associated costs. For example, AI-enabled CDI programs increase productivity by 50 percent and boost the case mix index (CMI) by 5 percent. Technology is also playing a key role in automating tasks like chart reviews and prior authorizations, and reducing manual labor efforts can translate to a potential $265 billion in savings every year. Implementing customizable solutions can also enhance scalability and alleviate some of the administrative burdens that detract from patient-focused care.
Partnering with an experienced outsourced service provider can further eliminate obstacles posed by the shortage of experienced professionals while leveraging the latest technological innovations. Such partnerships provide access to advanced technical skills, process workflows, documentation reviews, and technology solutions, enhancing CDI and appeals processes. Augmenting the capabilities of internal RCM teams can significantly improve the overall healthcare delivery system.
Best Practices for Implementation
Additional key steps for a unified approach include:
- Education and training: Ensure continuous education and training for clinicians to optimize documentation and coding practices.
- Data-driven analytics: Allow for monitoring of performance and compliance and identify gaps and areas of improvement.
- Standardized process and tools: Implement documentation templates, clinical guidelines, and technology tools for increased accuracy and efficiency.
An operational model that integrates clinical administrative services with HIM, supplements professional resources, and automates many of the manual processes can alleviate many burdens. Fostering collaboration between clinical and administrative teams and leveraging technology can streamline operations, enhance patient care, and ensure financial sustainability. For more information on integrating clinical and revenue cycle operations, watch our on-demand webinar, Driving Revenue Cycle Efficiency with Unified Clinical and Administrative Services.
Matthew Bridge
