1. How is the RoundTable approach to RCM different than its competitors? Leveraging our depth of RCM and IT experience, RTSS customizes solutions based on our client’s needs. This includes people, process, and technology. We tailor these three integrated approaches to drive sustainable improvements in any area of your Revenue Cycle. With over 25 years of Revenue Cycle experience, our consultants have worked in prestigious & financially successful medical systems affording us the opportunity to learn from the best and pay it forward. Over the years we have learned what works and what doesn’t, thus creating our own catalog of Best Practices. As an RCM partner, we share these Best Practice solutions with our clients and offer elbow to elbow support to drive change and deliver exceptional results. 
  2. What have been some of the challenges to implementing a robust RCM operation in health systems and hospitals today? While there are many challenges to share, a long-standing obstacle is the disconnect between various departments of the revenue cycle including clinical departments. The potential impact to the revenue cycle begins when the patients account is registered. Every caregiver who interacts with a patients account can make a difference. Registrars create and update patient accounts with insurance information, clinicians are responsible for documentation quality which impacts charge capture, clinical department leaders are responsible for charge reconciliation to identify and capture missed charges, coders assign proper procedure and diagnosis codes for claims, billers resolve payer specific edits and prepare claims for submission, follow up specialists intervene when payment is delayed. Denials specialists fight for reimbursement and payment posters record the payments when received. The entire process from front, middle to end, is integrated. Oftentimes departments lack an understanding of this connectedness as well as their overall impact on the revenue cycle at large. This creates silos and many times can restrict efficiency. With shrinking profit margins and the implementation of the “do more with less theory”, revenue cycles must have a proactive & integrated approach to protecting its reimbursement. This means every caregiver must understand their place in the revenue cycle and adopt the “I make a difference” mindset.
  3. How have revenue cycle operations changed over time? Revenue cycle operations is constantly adapting to change. Movements such as EHR implementation or upgrades, hospital mergers, acquisitions or expansion, new reimbursement models and ever-changing payor policies have certainly changed the operations landscape over the years. This environment of rapid change has forced organizations to be nimble and adept at change management.  
  4. How important is it for a hospital/ health system to be proactive about their revenue cycle management– for instance, by using data analytics to predict patient behavior, and cut losses? (https://www.beckershospitalreview.com/finance/rcm-tip-of-the-day-use-data-analytics-to-predict-patient-behavior-cut-losses.html)  Being proactive about RCM isn’t just important, it’s mandatory. It’s the revenue cycle “preventative care” philosophy; acting now to prevent revenue cycle “sickness” in the future. A healthy revenue cycle is informed and prepared for potential pitfalls. For example, the OIG posts its upcoming target review areas on its website continuously. Staying in tune with their audit initiatives allows providers the opportunity to review these targeted areas and address any findings, before they land in the hands of the OIG. Additionally, staying abreast of payer behavior limits the risk of increased denials and/or potential write-offs. Using data analytics, hospitals can diagnose issues, predict outcomes and initiate enhancements. There are a variety of ways a revenue cycle can be proactive.  
  5. What does the future of RCM operations look like? What should health systems be mindful of? As new reimbursement models evolve and expand, healthcare organizations will need to proactively assess and adopt the necessary internal workflows required to maximize reimbursement under such models.  Additionally, we have moved into an environment of pricing transparency. Payers in some states are promoting financial incentives to members when they shop for healthcare. As a result, patients are becoming educated and savvy consumers. While payers and market competition may drive patients towards care at a lower price point, providers will need to develop strong and lasting relationships with their patients, promoting value over cost.