New Year, New Goals, Same Issues
Like many people, I try to set personal and business goals at the beginning of each year.
These goals range from healthy lifestyle changes to personal development to growth within our business. For example, my family bought me a monthly book subscription this year, so I will be striving to read more in 2023.
Many times, our goals follow us from year-to-year because we ultimately give up, whether that be intentionally because we think it’s too hard, or accidentally because we slowly slip back into old habits. So, like many, I have goals that tend to be the same from year-to-year.
This phenomenon also occurs within the revenue cycle process in healthcare organizations. Goals like reducing denials, reducing AR days, and increasing collection percentages tend to repeat yearly as the attempts are unsuccessful.
Walls, Barriers, Obstacles…
There are several factors that can attribute to not reaching intended revenue cycle goals. Some of these factors can include staffing shortages, poor training, inadequate processes for follow-up, and new Electronic Health Records. Unfortunately, some of these factors cannot be avoided each year.
However, an unexpected barrier is the increasing efforts of insurance companies to make sure you do not attain your goals. In fact, I have personally noticed that payer policy changes are occurring more and more frequently. The payers’ changes and other tactics are causing more denials and longer processing times.
It’s All in the Numbers
A recent survey from Experian Health showed that claims denials have increased between 10%-15% over the previous year. This increase in denials represents billions of dollars in the industry and is a potential profit maker for insurance companies. Furthermore, a 10% drop in revenue for most healthcare providers can be devastating.
As a result of all the pressure to collect every dollar possible, most revenue cycle departments in healthcare have reducing denials as their highest priority for the new year. In fact, nearly 3 out of 4 respondents to the Experian Health survey reported this as their highest priority for 2023.
So, Is Success Within Reach?
What steps can you take to combat the payers’ tactics and ensure you are meeting your revenue cycle goals in 2023? A few ideas to get started would be to quantify and categorize denials, improve patient data quality, optimize claims management software, and work with payers.
But like your New Year’s Resolutions that seem to go to the wayside by February 1, you must actively measure and hold yourself accountable to ensure long-term success. Incorporating key performance indicators into your monthly Revenue Cycle meetings and then holding everyone accountable to those standards is critical to success. Have the meeting, talk about the measures, discuss your findings, and implement the recommendations.
The payers are banking on the fact that you and your team will not follow through with your resolution or goals for the new year. Let’s resolve that this year we will meet our revenue cycle targets and maybe our personal resolutions as well.
Written By: David Caston, MSHA, MBA
LinkedIn: David Caston
