Lack of experienced RCM staff and Strategies for 2023 to Overcome them

Strategies to Overcome RCM Staff Shortages Challenges

The healthcare industry is facing workforce shortages, and revenue cycle management (RCM) departments are not immune to this challenge. While the lack of nurses and frontline medical professionals receives most of the media attention, RCM outsourcing companies have the opportunity to become vital partners for hospitals and healthcare organizations struggling with the shortage.

Why the lack of experienced RCM staff is rising?

RCM departments are critical pieces of the healthcare puzzle, substantially influencing the patient experience and the organization’s bottom line. From registration to billing and insurance follow-up, hospitals and healthcare organizations need to ensure timeliness and accuracy to avoid cash flow challenges. However, with too few people available for these tasks, the healthcare industry faces severe staffing shortages.

Some of the main reasons are:

• There is a shortage of personnel in revenue cycle roles, including front-end revenue cycle staff, patient experience representatives, back-office specialists, coders, coding specialists, and accounts receivable and denial management experts.
• The shortage existed before the COVID-19 pandemic, but it has been further complicated by increased needs and provider burnout.
• There is currently a high demand for billers and coders due to the increased demand for elective surgeries.
• Revenue cycle personnel are facing an unprecedented backlog of accounts receivable, which has shifted the challenges from being on the verge of layoff to working on a high volume of claims and complex denials.
• Many revenue cycle personnel are on the brink of burnout and looking at moving to higher-value jobs.
• Existing training programs for billing, Medical coding and HIPAA security requirements are falling short.
• Hospitals are facing a shortage of both clinical and administrative personnel, a lack of training capabilities, and an accounts receivable situation of an unprecedented magnitude.
• Vaccine mandates may exacerbate the staffing shortage, and as many as 17 million healthcare workers may be affected, including a significant percentage of administrative staff.

The pandemic has also shifted worker priorities, with many individuals preferring to work remotely or in a hybrid environment. Additionally, soaring wage costs, sign-on bonuses, outsourcing of jobs, and greater use of automation have played a role in mitigating the current staffing shortages at many hospitals and healthcare organizations. However, the shortage persists, with nearly half of the healthcare organizations reporting a severe shortage within their RCM or billing department.

Strategies to Address the Ongoing Healthcare RCM staff for Hospital Revenue Cycle Leaders:

Short-Term Strategies:

While traditional approaches like cross-training, effective workforce planning, and maintaining a bench of employees may offer short-term solutions to the current labor crisis, these methods may not be as effective in the revenue cycle industry due to the specialized nature of the work, which demands more management attention.

Using technology and automation to compensate for the lack of experienced RCM staff:

The emergence of technology in the workplace has led to an increase in the use of acronyms such as RPA, AI, conversational AI, and ML, which are all tools that can help improve human productivity. With staffing shortages becoming more common, automating repetitive tasks can reduce workload and increase efficiency. 

Need for workforce and workflow solutions: 

Technology is necessary to monitor the productivity of remote staff, but most hospitals and revenue cycle companies lack it. Operational data is crucial for the transformation of the hospital revenue cycle. Performance and productivity data of staff managing each revenue cycle process component determine the efficiency and efficacy of the overall revenue cycle and collection efficiency.

Administrators usually focus on revenue cycle KPIs rather than metrics indicating processing efficiency at each component process level. The current application infrastructure does not support the workflow efficiency sought by hospital administrators.

BillingParadise conducted a study that found agents spent less than 4 hours of their 8-hour shift on productive tasks. To address this issue, BillingParadise developed TeamBillingBridge, a non-intrusive tool that sensitizes the workforce on daily targets and provides dashboards to track productivity. Although it does not automate tasks, the focus on productivity led to a 7% reduction in costs within a month of deployment, which is crucial for hospitals to survive and succeed.

The integration of RPA, AI, and machine learning in the revenue cycle chain has transformed how business processes are carried out. Various success stories and RPA use cases exist, demonstrating the potential of these tools to eliminate repetitive and laborious tasks, ultimately driving increased market adoption.

The reliability of outsourcing as a strategy:

Outsourcing has been a go-to strategy across industries to manage staffing shortages and acquire access to skilled resources. In the healthcare industry, outsourcing is an effective means of eliminating workforce shortages and enabling a focus on desired outcomes. Healthcare outsourcing firms specialize in providing high-quality resources with defined productivity and performance standards for all key functional areas. These firms also work collaboratively with their clients to establish Service Level Agreements (SLAs) and outcomes-based relationships that keep the accounts receivable (A/R) under control.

Benefits of experienced outsourcing RCM staff:

Management by numbers and on-time deployment – By outsourcing, healthcare organizations can move key workforce management tasks such as employee hiring, training, operations management, and people administration to a best-in-class management environment governed by performance metrics.

Cost reduction – Outsourcing can help healthcare organizations reduce the overall cost of collection and improve margins. Additionally, outsourcing can reduce facilities, infrastructure, and technology costs. Outsourcing also offers the flexibility to scale up headcount during demand peaks without any issues.

Plug revenue leakage – Outsourcing can help healthcare organizations recover revenue that was previously lost due to inefficient processes. For example, outsourcing coding services can result in revenue leakage being plugged to a magnitude two times that of the annual fees paid for outsourced coding services.

Technology – Outsourcing can help healthcare organizations adopt progressive technologies to deliver exceptional patient care while the outsourcing partner provides great revenue cycle outcomes.

Workflow and workforce management – BillingParadise, for instance, offers a technology-enabled delivery model, measuring the productivity and performance of its agents at a granular level. This unprecedented focus on transactional efficiency and iterative quality improvement initiatives drives greater financial outcomes for hospitals or healthcare systems.

RCM leaders are left with two options:

Keep RCM efforts in-house or invest in the expertise of outsourcing professionals. While investing in personnel and technology to create in-house RCM processes that are as efficient and effective as possible seems daunting, outsourcing professionals already have the talent and infrastructure in place to deliver innovative solutions that justify the decision.

The healthcare RCM outsourcing market is expected to grow by $1.67 billion from 2022 to 2026, and outsourcers must deliver a solution that includes critical workforce performance management tools, patient engagement strategies, and purposeful automation. Automation can increase staff productivity and reduce redundancies, enabling staff to focus on higher yield and revenue-producing tasks. Outsourcers must also streamline processes, increase the speed of revenue, and create an improved patient financial experience.

Healthcare organizations have implemented automation to help with several RCM tasks, including insurance follow-up, complex claims, denial management, program enrollment, and patient-pay follow-up. To remain competitive, outsourcing companies must incorporate these tasks into their back-end RCM services.

The trend is evident, and outsourcing companies have a significant opportunity for growth. Outsourcers must be ready for this active market shift and be able to serve the full needs of RCM processes, including a personable client and patient experience. With the right approach, outsourcers can become vital partners for hospitals and healthcare organizations facing workforce shortages and RCM challenges.