The document discusses the critical importance of revenue cycle management (RCM) performance amid declining cash flow and patient visits in healthcare. It highlights key issues affecting profitability, such as coding errors, reimbursement challenges, and operational inefficiencies. The document also outlines guidelines for maximizing reimbursement through improved coding, efficient processes, and leveraging technology.

1. Revenue Cycle Management: What Matters Now
Why RCM Performance Is More Important Than Ever
Guest Host
Marnie Iorio, Tim Coan,
VP of Business Development CEO
ALN Medical Management ALN Medical Management

2. Downward Spiral
Cash
Problems
Declining Reduced Lower Lower
Patient Visits Charges Collections Profitability • Physician
Compensation
• Debt Service

3. Drivers Of Cash Flow
Complete Charge
Processes Proper Coding
Capture
Technology Automation of RCM
Robust PM System
Tasks
Detailed Operating Trended Results
Data Metrics Reporting

4. Practice Cost Allocation
Occupancy
9%
Other
Operating
13%
Physician
Compensation
50%
Staff Salaries
& Benefits
28%

6. Reimbursement Issues
Practice Payer Patient
• Sub-standard • Unknown allowed • Incorrect, missing
coding charges demographic
information
• EDI leakage • High denied
(high rejects, claims rate • Failure to collect
lost claims, no co-pays,
claim scrubbing) • Lack of follow-up deductibles, and
on non-response balance due at the
claims time of service

7. Keys to Maximum Reimbursement
1. Improve coding and reduce denials
2. Fix the EDI process
3. Increase time of service collections
4. Shorten the cycle on appeals
5. Leverage all RCM technologies
6. Manage with data and metrics

8. Key Performance Indicators
Net Days in Accounts Receivable (A/R) Shown by trending overall A/R performance
Aged A/R as a Percentage of Billed A/R Shown by trending receivable collectability
Shown by trending point-of-service collecting
Point-of-Service Cash Collection
efforts
Cost to Collect
Shown by trending operational performance
Cash Collection as a Percentage of Adjusted Shown by trending the revenue cycle to convert
Net Patient Services Revenue net patient services revenue to cash
Bad Debt Shown by trending the effectiveness of self-pay
collection efforts and financial counseling
Charity Care
Shown by trending the local ability to pay
Shown by trending the claims generation
Days in Total Discharged Not Final Billed
process.
Source: Healthcare Financial Management Association (HFMA) , January 2010

9. RCM: What Matters Now
Why RCM
Performance is
More Important
Than Ever
Interoperability:
Managing Day
The Coming
to Day RCM
Merger of
Performance
Clinical and
with Data
Financial Data
Revenue
Cycle
Management
RCM
Reporting: Technology
What to Watch, Enhanced RCM
When to Watch
The Future of
Coding and
Compliance