When it comes to optimizing your healthcare organization’s revenue cycle, hiring a revenue cycle consultant can provide valuable expertise and guidance. However, before engaging a consultant, laying the groundwork to ensure a successful partnership is crucial.

Lori Intravichit, CEO of Sunlit Cove Healthcare, said:

While hiring a revenue cycle consultant can offer significant benefits, it's essential to be aware of potential pitfalls. One common pitfall is relying solely on the consultant's expertise without actively engaging internal stakeholders. Failing to involve key departments and decision-makers can hinder the implementation and sustainability of proposed improvements. Another challenge is not clearly defining expectations and deliverables from the consultant. Without a well-defined scope of work and measurable goals, it becomes difficult to hold the consultant accountable for results. Additionally, some consultants may lack industry-specific knowledge or fail to adapt their strategies to the unique needs of the organization. Careful evaluation and clear communication are necessary to mitigate these pitfalls and ensure a successful partnership with a revenue cycle consultant.

This article will outline the necessary steps to take before hiring a revenue cycle consultant, including financial analysis, identifying key performance indicators (KPIs), determining priorities, engaging all affected departments, selecting the right consultant, and ensuring accountability for improvement.

1. Complete a Financial Analysis of Your A/R Current and Projected:

Before engaging a revenue cycle consultant, conduct a comprehensive analysis of your organization’s accounts receivable (A/R). This analysis should include an assessment of current financial performance, including revenue, collections, denials, and write-offs. Additionally, projecting needed future financial trends can help the consultant identify potential areas for improvement and set realistic goals.

2. Identify Your Top 5 KPIs:

Key Performance Indicators (KPIs) are essential metrics that provide insights into your revenue cycle’s financial health and operational efficiency. Collaborate with stakeholders to identify the five most critical KPIs for your organization. These could include metrics such as:

• Average Days in Accounts Receivable
• Clean Claim Rate
• Denial Rate
• Collection Rate
• Net Collection Percentage

3. List the KPI Levels vs. Goals:

Establish clear performance goals for each of the identified KPI’s. By comparing current KPI levels against these goals, you can assess the performance gaps and areas in need of improvement. This step provides a baseline for measuring the success of the consultant’s efforts and tracking progress throughout the engagement.

4. Decide Which KPIs Will Be Your Priority for the Consultant:

Based on the financial analysis and the significance of each KPI, prioritize the areas that require immediate attention. By focusing on a few key metrics initially, you can ensure concentrated efforts and maximize the impact of the revenue cycle consultant’s expertise. This approach helps streamline the consulting process and enables more efficient resource allocation.

5. Include All Departments Affected:

A successful revenue cycle improvement initiative involves collaboration among various departments. Ensure that all departments affected by the revenue cycle, including Case Management, Patient Access, Medical Coding, HIM (Health Information Management), and Billing/Collections, are actively engaged. Each department plays a crucial role; their cooperation is vital for achieving sustainable process improvements.

6. Determine When All Departments Will Be Available to Work Closely with the Consultant:

To optimize the consultant’s engagement, coordinate schedules to ensure that all relevant departments can work closely with the consultant. Having adequate representation from each department during the consulting process is essential. This collaborative approach fosters a comprehensive understanding of the organization’s revenue cycle challenges and facilitates effective problem-solving.

7. Decide Which Consultant Firm Will Best Meet Your Needs:

Choosing the right revenue cycle consultant is critical for success. Evaluate various consulting firms based on their expertise, experience, track record, and alignment with your organization’s needs. Consider the level of support and guidance required and select a consultant who can provide the necessary training, resources, and ongoing support to drive sustainable improvements.

8. Hold the Consultant Accountable for Improvement Measured by Meeting KPI Goals:

Accountability is crucial to ensure the desired outcomes from the revenue cycle consultant engagement. Set clear expectations with the consultant, establish regular progress review meetings, and monitor the performance against the predefined KPI goals. Regularly assess the consultant’s effectiveness in driving improvements and promptly address any concerns or deviations.

9. Ensure Sustainable Process Improvements and Training:

The end result of a revenue cycle consulting engagement should go beyond immediate improvements. It should leave the client with sustainable process enhancements and empowered staff. Work with the consultant to develop training materials tailored to your organization’s needs and ensure that all staff members receive comprehensive training. This knowledge transfer ensures that the positive changes are embedded within the organization and can be sustained in the long run.

In conclusion, before hiring a revenue cycle consultant, investing time and effort in preparation is crucial for a successful engagement. Completing a financial analysis, identifying KPIs, involving all affected departments, selecting the right consultant, and ensuring accountability are essential steps in the process. By following these steps, healthcare organizations can expect sustainable process improvements, enhanced staff training, and ultimately, a more optimized revenue cycle operation.

Ready to get started? We can help! Contact us, email Lori@Sunlitcovehealthcare.com or give us a call at (727) 278-3009!

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Sunlit Cove Healthcare Consultants

We provide management and consulting services to help healthcare businesses run efficiently. Navigating the dynamic and complex revenue cycle management is a challenge for many health plans, health care vendors, and providers. Our consulting services are available to assist with your day-to-day operations and provide expertise in growth and change management. We manage all aspects of your enterprise from the development of the revenue cycle management process to the completion of your business cycle.

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