Engaging an experienced revenue cycle management consultant can help providers significantly enhance their revenue capture by identifying issues leading to revenue loss and providing corrective solutions tailored to their practice. A qualified consultant conducts an end-to-end assessment of the provider’s complete revenue cycle, analyzes the data to pinpoint problem areas, and presents targeted recommendations to improve processes, close performance gaps, reduce revenue leakage, and maximize appropriate reimbursement.
Below is an overview of how an RCM consultant can help boost medical practice revenue:
Assessing Current Revenue Cycle Processes and Performance
The first step an RCM consultant takes is conducting a thorough current state assessment of the provider’s end-to-end revenue cycle processes, from appointment scheduling to final payment collection.
This involves extensive data analysis of:
- Payer contract rates and fee schedules
- Charge capture and charge lag metrics
- Coding distributions, including risk of upcoding or downcoding
- Claim submission volumes, rejections, denials, and appeal success rates
- A/R days, bad debt, and collection rates
- Revenue cycle technology utilized and workflows
- Staffing levels, roles, and productivity
- Financial metrics like total revenue, collections, denials, and net revenue
The assessment will identify areas of the revenue cycle that are functioning well versus problem areas causing revenue leakage, longer collection cycles, or compliance risks.
Uncovering the Root Causes of Revenue Loss
Simply identifying problem areas is insufficient – the consultant must uncover the root causes of revenue loss in order to provide actionable solutions.
Examples of root causes could include:
- Outdated fee schedules resulting in inaccurate pricing and under-reimbursement
- Lack of payer contract clarification leading to incorrect balance billing
- Incomplete clinical documentation and coding issues causing inappropriate E&M levels
- Billing errors like duplicative claims, expired authorizations, no pre-certifications
- Insufficient denial management procedures failing to prevent and reverse denials
- Poor patient financial communications leading to lower collections
An experienced consultant will dig deep to understand why deficiencies exist and how they specifically impact revenue and performance.
Quantifying Opportunity Costs and Revenue Leakage
The consultant should quantify the impacts of the identified issues in terms of opportunity costs and revenue leakage. This demonstrates the scope of the problems and the financial upside if they are addressed.
For example:
- 40% of E&M codes downcoded resulting in $100,000 under-reimbursement
- 30% denial rate worth $500,000 in reversed claims
- 20% bad debt suggesting $350,000 in collectible patient payments
Having dollar amounts tied to performance gaps spurs action by revealing the revenues at stake. The provider can then measure the ROI of initiatives to capture these lost revenues.
Presenting Targeted Solutions and Process Improvements
Based on their experience and the provider’s specific issues, the consultant recommends targeted solutions to resolve the biggest problem areas and revenue leaks.
The consultant may present solutions for:
- Improving charge capture through front-end process changes and staff training
- Implementing documentation and coding best practices to optimize reimbursement
- Regular payer contract reviews to maximize fee schedules
- Claim scrubbing to prevent rejections and denials pre-submission
- Automated denial management workflows to efficiently appeal denials
- Patient-centric collection techniques like payment plan options
The consultant explains how implementing their solutions will directly translate to dollars recaptured. This builds the business case for change and secures leadership buy-in.
Providing Hands-On Implementation Assistance
The consultant does not simply hand off recommendations and expect the provider to self-implement.
An effective consultant will provide hands-on assistance to:
- Work closely with staff to implement new processes and workflows
- Create documentation tools, forms, templates, and training materials
- Set up and test new technologies like automated denial management systems
- Liaise with payers to negotiate improved contract terms
- Conduct regular optimization to refine solutions over time
- Doing the heavy lifting to turn recommendations into reality ensures solutions stick and have maximum impact.
Overcoming Internal Resistance to Change
A common challenge consultants face when trying to implement revenue cycle solutions is internal resistance to change from the provider’s staff. Employees may be set in their ways, defensive about problems identified, or not see the need for solutions proposed. This can significantly hinder adoption of new processes or technologies.
An effective consultant anticipates resistance and develops a customized change management plan. They interview staff to understand their concerns and identify change champions. They involve staff in designing new workflows to increase buy-in. They highlight how solutions will make jobs easier and reduce frustration. Presenting quantifiable impact helps overcome resistance when staff realize the financial upside. Consultants act as change agents to drive culture shifts towards best practices.
Ongoing training and coaching also smooths the transition. Consultants provide shoulder-to-shoulder guidance and encouragement as staff adjust to new systems. Leadership alignment is critical so managers reinforce changes. Open communication and celebration of quick wins maintain engagement. With the right change management approach, consultants can turn resistance into enthusiastic adoption.
Leveraging Technology to Bolster Solutions
In many cases, technology tools are needed to enable and sustain process improvements.
Consultants may recommend solutions like:
- Automated denial management and appeal platforms to reduce write-offs.
- Enhanced analytics for better visibility into revenue metrics.
- Patient payment portals and financing options to improve collections.
- Clinical documentation improvement tools for more accurate coding.
- Claim scrubbing software to cut down on rejections and denials.
These technologies provide efficiency, consistency, compliance, and scalability. Consultants ensure optimal integration with existing systems like EHRs for ease of use. With domain expertise, consultants specify system requirements and evaluate vendor options saving providers costly technology missteps.
Consultants also maximize use of current technologies that are under-utilized. For example, increasing adoption of patient portals among the patient base. With a tech-savvy approach, consultants unlock more value from technology investments.
The Lasting Value of Process and Culture Change
The most powerful long-term result from revenue cycle consulting is ingraining sustainable process, operational, and cultural changes within the practice. With proper change management, consultants transfer knowledge so staff retain skills and disciplines. Operational excellence becomes baked into the fabric of the organization rather than dependent on an outsider.
Consultants also influence leadership to prioritize continuous revenue cycle assessment and improvement. They provide templates for self-auditing performance and uncovering new opportunities. The culture shifts to one adept at self-correction based on data. By teaching others to fish, the legacy of a consultant’s impact lives on.
Monitoring Ongoing Performance and Revenue
Lastly, the consultant should monitor performance and revenue metrics over time to validate that solutions are working and remaining effective. If metrics begin to slip over the following months, the consultant can advise on corrective actions to realign improvements.
Additionally, the consultant may identify new revenue cycle problem areas as they emerge over time. New medical billing rules, technologies, and regulations necessitate ongoing performance assessments and solution updates from the consultant.
The Power of an End-to-End Perspective
Comprehensive medical revenue cycle management requires an end-to-end perspective across clinical, operational, financial, and technological facets. No single staff role encompasses the full revenue cycle. As an independent third-party, an experienced consultant offers this overarching viewpoint and ability to pinpoint cross-functional problem areas that internal staff may not see.
Their breadth of healthcare revenue cycle exposure also allows them to adapt proven solutions from other specialties and practice types. An effective consultant brings an objective, data-driven approach centered on measurable financial impacts – a perspective that providers often lack when deep in the day-to-day workflows.
Key Benefits of Revenue Cycle Management Consulting
When considering whether to engage a consultant, medical providers should understand the tangible benefits:
- Increased reimbursement rates through optimized payer contracts, documentation, coding, and billing.
- Reduced denials and improved appeals success to capture more owed payments.
- Lower operating costs through improved staff productivity and reduced rework.
- Enhanced analytics and insights into revenue performance.
- Improved patient satisfaction through upfront financial communications and transparency.
- Reduced compliance risks and audits with improved documentation and coding.
- Higher staff skill levels and adoption of revenue cycle best practices.
The financial outcomes typically include:
- 10-20% increase in collected revenue
- 5-10% reduction in total cost to collect
- 2-3% increase in staff productivity and capacity
- 60-80% reduction in A/R days outstanding
Choosing the Right Revenue Cycle Consultant
To achieve maximum benefit, providers should ensure they select the right consultant for their practice.
Ideal consultants have:
- Deep knowledge across the entire revenue cycle, not just focused expertise in one area.
- Experience with the provider’s specialty – from cardiology billing nuances to orthopedic coding specifics.
- Exposure to a wide variety of EHR, PM, and billing systems.
- Quantifiable results delivering millions in recouped revenue for past clients.
- Engagement models tied to financial outcomes and performance improvement.
- Ongoing consulting relationships versus one-off projects.
- Complementary staff education services to build internal capabilities.
By selecting a consultant who meets these criteria and takes an end-to-end approach targeting the biggest financial impacts, providers can maximize their revenue cycle performance. The dollars recaptured and costs reduced make the investment in an experienced consultant many times over. In today’s changing reimbursement environment, a tight and optimized revenue cycle is a key determinant of every medical practice’s financial sustainability and success.
