In our previous article, "Enhancing Efficiency: Tackling the Challenges of Clinical Administrative Burdens," we discussed the importance of aligning clinical operations and revenue cycle management (RCM). Clinicians' primary focus is on patient care, clinical outcomes, patient experience, and professional development, while revenue cycle staff concentrate first on ensuring financial health, compliance, and operational excellence. Bridging the gap between these areas can enhance patient care, streamline efficiencies, and reduce claim denials.
Healthcare organizations can incorporate several best practices for the most effective approach to meet the dual objectives of delivering quality patient care while also achieving operational efficiency and financial stability.
Secure Leadership Support and Alignment. Leadership support from both clinical operations and revenue cycle management is instrumental in driving change and fostering an environment of cooperation and mutual respect between different departments.
Establish Collaborative Cross-functional Teams. A multidisciplinary approach facilitates comprehensive problem-solving, encourages diverse perspectives, and ensures that all aspects of patient care and documentation are considered. These teams should include a diverse mix of professionals such as clinical staff, health information professionals, clinical documentation improvement specialists, and revenue cycle experts. Regular meetings and open lines of communication are crucial for addressing challenges, sharing best practices, and fostering a culture of continuous improvement.
Invest in Education and Training. Continuous education and training programs inform both clinical and health information staff of the latest regulatory requirements, technology advancements, and best practices in health information management (HIM).
Ensure Data-Driven Decision Making. Leveraging data analytics is key to identifying gaps, measuring performance, and guiding strategic decisions. Establishing metrics and benchmarks allows organizations to track progress over time and adjust strategies as needed. These insights can help align the goals of clinical operations and HIM, ensuring that both departments work towards a common objective of improving patient care and operational efficiency.
Foster Continuous Improvement through Audits and Feedback. Regular audits and feedback loops enable healthcare organizations to benchmark against industry standards, identify areas requiring improvement, and implement strategic enhancements based on real-world data. These continuous improvement processes help healthcare organizations stay ahead of regulatory changes, clinical care guidelines, and medical advancements.
Leverage Technology and AI-Powered Tools. Implementing technology, including AI-powered tools, process automation, and machine learning, can alleviate the strain of routine tasks on both staff and resources. These tools can also enhance patient care and provide clinicians with more accurate and timely information, improving accuracy, minimizing denials, and streamlining care and reimbursement processes.
Engage a Strategic Partner. The right partnership supports internal staff through comprehensive services tailored to both inpatient and outpatient settings, clinical documentation integrity (CDI), utilization management (UM) services, clinical prior authorizations, denied claim reviews, and optimized clinical support through physician advisory services. Seek experienced outsourced service providers capable of providing rapid scalability with technical skills and technology solutions, focusing on quality assurance and performance monitoring processes and a commitment to innovation and continuous improvement.
Implementing a collaborative model that eliminates the siloes between revenue cycle management and clinical operations impacts the quality of patient care while driving organizational success. Download our whitepaper for more insights that can enable healthcare organizations to enhance the quality of clinical administrative services, benefiting patients while improving financial health.
