Revenue Cycle Management

LBMC, a top 3 accounting and business consulting firm in the Southeast, is pleased to announce the addition of Lane Jackson as Shareholder to its rapidly growing healthcare advisory practice. Jackson joins LBMC’s healthcare consulting practice as leader of the firm’s revenue cycle service offering.

Jackson brings 30 years of experience serving healthcare provider clients exclusively. Prior to joining LBMC, he served as partner and healthcare commercial advisory practice lead for a large professional services firm with over 7,000 domestic employees. His wide-ranging experience includes leading complex revenue cycle transformation, compliance, integration, consolidation, restructuring and electronic medical record (EMR) implementation engagements, including for a $5 billion healthcare provider. Jackson has extensive experience serving healthcare provider systems, academic medical centers, large physician groups and other specialty providers.

“We are thrilled to have Lane join LBMC to lead our growing healthcare revenue cycle service offering,” said Mark Burnette, Shareholder, Practice Leader, LBMC Advisory Services. “Given ongoing financial concern, regulatory uncertainty and recruitment and retention challenges, a healthy and effective revenue cycle is more critical than ever. Lane brings revenue cycle expertise to broaden our healthcare advisory capabilities to meet clients’ needs in this ever-changing environment. As our clients navigate challenges, we are proud to continue to evolve, providing solutions in consulting and business intelligence that help them protect what they have and take advantage of opportunities.”

Jackson holds his Bachelor of Science from Western Kentucky University and is a member of HFMA and AICPA. He completed the Enterprise Decision Making Program at Kellogg School of Management at Northwestern University. He is a noted thought leader and frequent presenter, author and moderator at conferences, including President Obama’s Commission on Care, Veteran’s Administration Revenue Cycle Assessment.

How can a healthcare organization improve its revenue cycle management?

To improve revenue cycle management, healthcare organizations should focus on streamlining patient registration, verifying insurance eligibility, enhancing coding and documentation practices, optimizing claims submission, improving denial management, utilizing revenue cycle analytics, implementing clear patient financial policies, enhancing patient communication, embracing technology solutions, providing regular staff training, fostering collaboration between departments, and effectively manage vendors that support the revenue cycle. Implementing these strategies requires a comprehensive approach to revenue cycle management. Regularly assess performance, monitor key metrics, and adapt processes to address specific challenges and improve financial outcomes.

Why is the revenue cycle so difficult to enhance and transform to achieve best practice performance?

Improving the revenue cycle can be difficult given the overall complexity and linkage of all revenue cycle functions. This complexity is due to various factors. Firstly, the healthcare industry has a multitude of payers, including government programs, private insurers, and self-pay patients, each with their own reimbursement rules and requirements. Additionally, coding and billing practices are highly intricate, requiring accurate documentation and adherence to numerous coding guidelines. The evolving regulatory landscape adds further complexity, as providers must navigate changing reimbursement policies and compliance standards. Furthermore, the vast amount of patient data, fragmented information systems, and the need for interoperability pose challenges in streamlining processes and ensuring seamless data flow. Moreover, the increasing patient financial responsibility, with high deductibles and copayments, demands effective patient communication and robust financial policies. To overcome these complexities, healthcare organizations must adopt advanced technologies, implement efficient workflows, and prioritize continuous staff training and compliance.

Complex revenue cycle operations require a multitude of specialists and subject matter experts that can be trusted to help you make the right decisions. Our deep bench of revenue cycle, financial, operational and clinical personnel allow us to bring the right resources to you.

What RCM Metrics You Should Care About?

The most valuable RCM metrics change based upon provider type and other factors. Broadly, we believe the following to be among the most important to measure, monitor and use for course correction. Healthcare organizations should monitor several key metrics to assess the effectiveness of their revenue cycle management. Here are some important metrics that they should pay attention to:

1. Collections as a Percentage of Net Revenue: This metric measures the cash collected as a percentage of net revenue and is typically calculated using a net revenue lag period.
2. Denial write-offs as a percentage of net revenue: This metric uses actual write-offs necessitated by denials as a percent of net revenue and is used to benchmark overall denial management performance.
3. Initial Denial Rate: This metric uses the total initial denied charges as of percentage of total charges submitted and allows for assessment of overall denial management efficiency.
4. Bad Debt as a Percentage of Net Revenue: This metric is calculated by using bad debt write-offs as a percentage of net revenue and is used to benchmark bad debt management performance.
5. Cost to Collect: This metric matches overall revenue cycle cost with collection amounts and helps determine how efficient the revenue cycle is.
6. Aged Accounts Receivable (A/R) as of Percentage of Billed A/R: This metric highlights how long it takes to adjudicate claims and identifies “at risk” A/R balances.
7. Insurance Verification Rate: This metric reflects to what level patient access functions are timely, accurate and efficient. It is the total number of verified encounters over the total number of registered encounters.
8. Days in Discharge Not Final Billed (“DNFB”) A/R: This metric is the total DNFB divided by average daily revenue. The days in DNFB should be approximately the number of established bill hold days.
9. Late Charges as a Percentage of Total Charges: This metric helps evaluate revenue capture efficiency and is calculated as the charges with a post date > established days from date of service over total gross charges.
10. Days Revenue in Credit Balance: This metric helps evaluate the effectiveness of credit balance management and is the total A/R credit balances divided by average daily revenue.
11. Patient Satisfaction: While not strictly a financial metric, patient satisfaction plays a crucial role in revenue cycle management. Satisfied patients are more likely to pay their bills promptly and engage in positive financial interactions, reducing the risk of bad debt or collection challenges.

Monitoring these metrics regularly and comparing them against industry benchmarks can help healthcare organizations identify areas for improvement, track performance over time, and implement strategies to enhance revenue cycle management.

What should I look for in a health care advisor?

It is obvious that any advisor should have the deep technical expertise and experience to help you solve issues. As important, you should have an advisor that you enjoy working with and helps foster the right culture. Large transformation projects, and even those smaller in scale, require working through difficult issues and frequently working long hours. Our team at LBMC takes pride in our collaborative and positive approach to helping our clients.