RCM is much more than just a cash flow proposition; rather, it’s all about the peace of mind that comes from maintaining a constant process review and positive financial picture across your organization. When your RCM function runs smoothly, everyone can keep their focus squarely on doing what they’re supposed to do to ensure optimal outcomes.

Even a smooth process may not be an optimal process. Opportunities for improvement are present within processes far and wide. Therefore, we recommend taking a fresh look at elements of your RCM through a critical lens and pursuing improvements where they are needed—and in cases where it’s practical.

As a leading long-term care consulting firm, we at Richter believe that such review should account for all phases of operation—from pre-admission all the way through post-discharge collection. It’s not just following a claim; rather, it’s following a client throughout the continuum of care. That begins with capturing all relevant data prior to admission into care. After all, if you’re not managing RCM well on the front end, your back end won’t function well as a result.

It is not necessary to pursue a systematic review of all RCM processes. You can start with a process you have identified as a concern. For example, a detailed review of your revenue cycle billing process could potentially identify unnecessary, redundant or inefficient steps. Through careful review, you may find you can streamline – or even eliminate – some through targeted strategies. Drilling down even further, you may handle your deposits manually…is that really the most efficient and effective way of accomplishing this task? Today, many banks enable LTPAC providers and other entities to process payments electronically. So, ask yourself, and your team members:

• Could that help us?
• Could it increase efficiency and productivity?
• Could it minimize or eliminate mistakes in the cash posting process, as well as in other areas?
• If we adopt it, what could we empower our people to do with some newly found free time?

Your analysis and review shouldn’t stop there. Payment and compliance reform will be an enormous challenge for the entire post-acute care spectrum moving forward. Many hospitals and home care agencies employ coders. Skilled nursing facilities generally don’t—and under PDPM, ICD-10-CM codes will drive clinical classifications into which clients are placed, which, in turn, drives reimbursement. Knowing which codes to include in various areas of the MDS assessment will be critical in order to capture comorbidities properly and thus ensure the highest case mix for each component of PDPM. This already is an area of great struggle for many LTPAC providers, so review of current processes should be a top priority for you.

Yet another area to review in long-term care revenue cycle management is census management. The Interrupted Stay policy was implemented along with PDPM on October 1, 2019. This extends the time period that a Medicare Part A clients can be out of a given facility (from less than 24 hours to less than 72 hours) without affecting the assessment schedule.

Currently, providers struggle with the documentation handoff between clinical and financial. At Richter, we see too many examples where facilities have not adequately accounted for this effect on revenue, claims, consolidated billing, compliance and other issues.

Overall, you should take a critical look at the lifecycle of the claim to really understand where your pressure points are; where weaknesses exist; and how to identify and address those weaknesses. In the end, your LTPAC and its clients will benefit from a top-down review of all processes that impact RCM.

Contact Richter

Do you have questions about optimizing your RCM process through review, or other RCM challenges? Read our e-book, “Six Strategies to Optimize Your LTPAC Revenue Cycle Process” or call Richter’s revenue cycle management consultants at 866-806-0799 to schedule a free consultation.

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