In large healthcare organizations, effective communication can be challenging. Sometimes that can be complicated by the fact that it can feel like revenue cycle operations and clinical operations and even IT all speak foreign languages. To tackle this challenge head-on, more and more organizations are bridging the gap by creating a brand-new role that lives in the grey area between these groups whose primary purpose is to act as a translator and liaison.
When issues arise that require effective communication between various areas that may not natively speak each other’s language, wouldn’t it be ideal to contact your helpful Revenue Cycle Liaison whose job it is to smooth out communication challenges and misunderstandings in order to push toward a successful resolution? Since this is not a traditional role in most organizational structures, it may require some legwork to create an entirely new department that this role can live within, but those who have made the effort to do so have reaped the benefits.
The Revenue Cycle Liaison
With the creation of a department that can act as a liaison between operations and the revenue cycle, your organization will have a permanent home for the challenges and issues that can otherwise easily slip between the cracks because of a lack of understanding and therefore ownership. This department would be the point of contact for operations to find answers to any revenue cycle-related questions or issues and vice versa.
Since the process of creating an entirely new department can be a bit daunting, here are a few items to consider to get you started:
How many service lines or specialties currently exist across the organization?
- This will assist in determining how many resources you will need to fill this role.
- Does the volume for a given service line justify a one-to-one resource or can you group like services together?
What information is lacking for operations to be successful and understand where to make improvements in the revenue cycle?
- Is there a set of key performance indicators that this new department will be responsible for monitoring on a weekly or monthly basis?
- Define, build and educate stakeholders about the reports that can be used to ensure successful daily operations.
- Do your clinical operations leaders need feedback from Coding as to why charges need to be reviewed? By understanding the reasons charges are stopping, they may be able to improve their workflow or target training to avoid delayed revenue.
- Why are there claim holds prior to submission to payors? Are they missing critical information when they hire a new provider? Can you create front-end training from registration issues to avoid claim holds?
- What type of denials do they receive? Are there any details to share to avoid the denial from occurring in the future?
Are users struggling with the EHR system and looking for improvements?
- Are there any system enhancements to stop a charge to make sure the registration is correct prior to payor submission?
- Are there edits that would be helpful to add to stop a charge for review prior to submission to increase reimbursement?
Review and define current issues that are causing inefficiency.
- Consider how this new role could pull together necessary stakeholders to develop workflows or processes that will improve challenging situations.
After establishing an initial set of responsibilities and subject areas for the Revenue Cycle Liaison role to manage, establish regular meetings including both revenue cycle and operations and with your Liaison at the helm. You’ll find that you will start bridging the gap and communication will improve leading to far-reaching benefits for the bottom line and the patient experience.
These are just a few items that a revenue cycle liaison department can assist operations with to increase revenue opportunities, improve reimbursement and help with overall revenue cycle satisfaction. If the idea of creating a Revenue Cycle Liaison position within your organization is of interest to you, but you could use some guidance in doing so, The Wilshire Group can help! We have successfully established these departments for partner organizations to great success and have created a roadmap to smooth out the process based on those experiences. If better cross-functional communication and issue resolution for those challenges that touch both clinical operations and revenue cycle sound appealing, give us a shout. We would be happy to meet with you, share our experiences, and discuss further.
