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How to Implement the Rev Cycle Team For the Future Today

The Rev Cycle team of the future will include Data Scientists, Business Analysts, Behavioral Coaches, and Software Subject Matter Experts who can leverage the expertise, data, and tools to make billers and coders more productive. This trend is already underway in payer organizations, health systems, and integrated delivery networks who have the scale and the capital to afford significant capital investments.

Unfortunately, this is out of reach for most independent practices because the investment of an additional $233,000 - $308,000 does not make financial sense. However, there is a way for practices to have the same level of expertise and resources as large health systems without breaking the bank. This is the way of the future.

Why this trend is occurring:

Since 1990 the increase in administrative staff has significantly outpaced the increase in physicians in healthcare. Now over 62% of healthcare employees are administrative (non-clinical) staff (1). These administrative costs are out of control and put significant pressure on independent physician practices who want to remain independent.

Simultaneously the administrative and regulatory requirements from government and commercial payers put financial stress on the bottom line for independent practices.

In order to preserve a healthy balance of independent physician practices in the community, groups cannot continue to hire more and more back office staff. There must be a better way that is not cost-prohibitive for independent practices.

Traditional org chart vs. future org chart:

Many practices divide work across people (billers, coders, charge posters, AR specialists, etc.) and across processes in the Rev Cycle: Front End (registration, prior auths, etc), Mid Rev Cycle (coding/charge review), and Back End (insurance, patient AR, etc).

Coders and billers in the Mid Rev Cycle make changes to 48% of encounters after clinical staff has completed the template in the EHR or CAC. The average coder or biller can handle 21 Encounters per Hour (EPH). Superstar billers can outperform the national average and may even reach 26-28 EPH while maintaining low denial rates, high accuracy, and minimal revenue leakage.

1st org chart

For a large 35 provider practice, they may have 5 billers/coders in the Mid Rev Cycle. These superstars can be difficult to find, expensive to keep, and worth every penny. They do the hard work of standing between the physician and payer. Doctors did not go to medical school to be coders and are frustrated with the coding work pushed on them as a result of Meaningful Use. Payers turn over 50% of their coding requirements each year and require perfection for claims to be paid. This work is critical, time-consuming, and relentless.

2nd org chart

To support increases in provider headcount and encounter volume, practice leaders can try to grow their team of superstars... or they can expand the skillset of their team to reach elite productivity levels. Unfortunately, neither of these strategies are financially sustainable in the long term. Continuing to grow the existing team only adds to the problem of administrative costs crowding out profitability. Expanding the skill sets necessary to reach elite productivity levels does not work for two reasons:

  1. A 35 provider practice does not need a full-time data scientist, business analyst, behavioral coach, and software subject matter expert dedicated to the Revenue Cycle.
  2. The investment is more than any productivity gains you could ever hope to recoup.

How to achieve this now:

When we studied our data and interviewed our clients, we were both frustrated and encouraged by the wide variety of Rev Cycle Productivity between practices. We were encouraged because some of these practices were able to unlock incredible value by outperforming the national average by 750-900%.

These groups were able to get more done with fewer resources. At the same time, we were frustrated that all clients did not get these same results. The White Glove experience was born out of these years of hard work and research.

Finally, there was a way to deliver the resources necessary for practices to reach elite productivity levels and to reliably predict (and even guarantee) the results.

3rd org chart

Now 1 Rev Cycle Ninja can do the work of 5 billers and coders. To deliver these results, the practice has access to the team and skill sets necessary to deliver these productivity gains without paying the full-time salaries for these resources. 

Over the next 5 years, all Rev Cycle Teams will begin to look like this. Top-performing practices are already over 5x more productive than their peers. Will this be the year you begin to transform your team to deliver better outcomes?

(1) https://hbr.org/2013/09/the-downside-of-health-care-job-growth

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