Achieving Success Through Effective RCM

Bill PickartDoug SmithOver the past five years, medical imaging enterprises have learned the hard way that adaptability and flexibility are prized qualities required for survival. They have weathered reimbursement cuts, increased scrutiny and the general feeling that they are ceding control of their businesses to outside agencies with agendas and motivations far different than theirs. What was once a smooth operation providing key medical information is now a daily battle to maintain viability. Among the key operational areas that have taken a front seat in the effort to grow and thrive is revenue cycle management, aka RCM. Simply defined, RCM is the facility’s cash register. When your patient calls to make an appointment for an MRI, for example, one question your scheduler will ask to complete the appointment process is whether the patient has insurance and if so, with whom. That seemingly innocent, routine question starts the process of revenue cycle management that can make or break your business. During that process, much can go wrong and often does. Claim denials, in particular, not only negatively affect cash flow, they also consume precious administrative hours. Using change as the catalyst for improvement Today, health care mergers and acquisitions are common. Some of these benefit the medical imaging community, some do not, simply because they reduce the care options and vendor choices available for imaging facilities. At a time when options are more important than ever, they are disappearing. Add to this the uncertainty over the long-term effects of the Affordable Care act and one sees potentially volatile times ahead for imaging. “Today, stability is the key to sustainability,” says Timothy Dyer, Executive Vice-president and CFO of Integrated Medical Partners (IMP), a Milwaukee-based firm specializing in revenue cycle management. “Stability is extremely valuable, but it can be fluid. In our case, our management team has lengthy tenure with IMP, which provides stability for our clients. Here, the stability we provide comes from our ability to adapt to the changing healthcare landscape and give our medical imaging clients useful, timely information with which to make important decisions.”   Dyer notes that more than ever, medical imaging enterprises need to manage their business affairs with a keen eye. “Between the Affordable Care Act, crippling reimbursement decreases, hospital affiliations, mergers and acquisitions, there is uncertainty.  The decision-makers in these facilities have to know where they need to go and how to get there. If RCM is under control and functioning properly, they can rely on their current numbers as a solid baseline for making strategic decisions. Without it, planning becomes arduous.” Planning through superior communication At each step along the RCM process, there are multiple opportunities for a breakdown in service due to poor communication. With established communication channels, both internal and external, RCM becomes ingrained and challenges become rare, while financial stability becomes the norm. “From the client’s perspective, financial stability means continuity of information - actionable information - plus consistent and predictable cash flow,” says Robert J. Kebbekus, IMP’s President and Chief Operations Officer. “The key today is for medical imaging leaders to focus on daily, weekly and monthly performances and compare them with forecasted goals,” says Kebbekus. ”By proactively managing and reporting on the variances, course corrections can be made before they become unmanageable. At IMP, we make it our business to know the ‘why’ of an issue when others are trying to figure out ‘if’ there is an issue. Providing multiple levels of communication to make sure the correct messaging is delivered helps our clients stay out in front of any challenges to their RCM.” For Kebbekus, one difference between smooth operations and uncertainty is the talent pool. “Most of the uncertainties are related to uncontrollable changes. Everyone here at IMP, from the management team on down, is keenly focused on CMS and payors. That focus helps us provide some light on the uncertainties and helps our clients build a successful strategy to remain relevant and minimize the negative influences of uncertainty in medical imaging.” Advice from experts So at a time when change and uncertainty are commonplace what should medical leadership be doing at this time to maximize RCM and merge them with market opportunities? “To start, a medical imaging business and RCM management requires proprietary software that is continuously improved and enhanced to meet the changes in healthcare,” says Dyer. “They should look for reporting packages that are customizable to the particulars of their operation and include interactive ‘drill down’ capabilities all the way down to patient level.  “Next, they need an RCM source that has an executive team providing them with a strategic view that goes way beyond billing.”  Kebbekus adds that while strategic planning is essential, the basics of daily RCM functions are necessary to help achieve any goal. “They must insist on full capture of the work performed by the physician, and their RCM source must make sure the group is paid correctly by the payors. At IMP, improving the quality of the group’s documentation to maximize the group’s reimbursements is standard operating procedure, as is capturing and resolving denials by insurance companies so the group gets every dollar they deserve. “And, of course, there must be state-of-the-art patient communication. I’m pleased to report that IMP brings all of these qualities to each client.” As medical imaging faces more surprises and more uncertainty, they will be demanding more attention from business and RCM resources such as IMP. The type of personal care that enables medical imaging facilities to make proactive, positive changes and control their own destiny rather than be controlled could mean the difference between relevancy and relegation. “It means providing solutions, not just identifying problems,” says Kebbekus.