Firstly let’s start by removing all the (TLAs)
‘three-letter acronyms’ that no one understands”. This has been the downhill for
many new managers who are hired to bring in a fresh perspective to RCM
operations. Few such new managers have the courage to engage head-on and
disseminate what each acronym means and get themselves and their teams up to
speed or change things around to better suit the industry in the future. The
others give in to the larger forces, not wanting to be challenged or mocked at
but there is surely nothing but failure and more delays down that path.
Healthcare RCM terminology and acronyms can be divided
into 2 groups
1. The acronyms that the industry recognizes Ex: RCM,
PMS, HIS, EDI, ERA, EFT, ACH, ICD, CPT, CMS, CMS1500, UB04, HIPAA, and the list
goes on.
Anyone who is not familiar with any of the above is not
your ideal team member
2. The acronyms that are created within your
organization that convert 30% of all communication into codes that only the
company veterans would understand. I have seen cases where the CEO of these
organizations sometimes struggles to keep up. Ex: ABC (Allied Billing Partner),
DS vs NS (Day shift vs. NS), TR (Training Room), CH (Clearing House). I burst
out when sometimes the standard industry norm acronym is used for a completely
different purpose. It also reminds me of the bizarre additions we saw to the
ICD list when ICD 10 was published. Here are some of them that will hurt your
tummy.
Coming back: A company that is planning to go
international, target large private equity or public offering will need to
seriously clean up shop internally. Over time, unless guided by a professional
the KPIs that are measured and the SLAs set in place can be counter-intuitive,
even worse never looked at by a senior representation to drive action. A famous
CEO once said that you can have all the information in the world but the only
information that matters are those that are actionable.
We have identified 2 KPIs that drive Healthcare RCM. As long as these 2 KPIs are monitored and improved under a compliant and regulatory framework, any RCM company can gain a strong competitive advantage:
1. How much are you collecting for your client
2. How fast are you collecting them
A lot ponder upon and digest. It all of a sudden
questions the 20-page executive summary you are used to and the hours of
internal operations meeting that you dread. It does not have been so bad. They
are simply exciting changes that can be implemented to get your teams on board
and ready to build a world-class Revenue Cycle Company.
