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How Medical Groups Can Tune up Front-end RCM Processes and Capture More Revenue

Medical groups are facing unprecedented cost increases as well as lost revenue that can never be recaptured. While many groups focus on back-of-house revenue cycle management improvements to improve profitability, both research and case studies show that breakdowns in patient-facing interactions at the front end of the patient encounter are where the biggest revenue losses occur.

In February 2022, Juli Forde Smith, Director at ZOLL® Data Systems, presented an MGMA webinar on how medical groups can reduce the administrative burden on front-end, patient-facing staff while at the same time, improving the profitability and financial health of medical groups. She highlighted specific financial and administrative challenges facing through case studies and the latest research, and shared tangible strategies for reducing losses that occur in the early stages of patient interactions and ways to optimize reimbursement.

The top challenges faced by medical groups include:

          • The revenue cycle management (RCM) process: Tracking, identifying, collecting, and managing incoming payments is more complex than ever.
          • A healthcare worker labor shortage: By 2026, it’s estimated that the United States will be facing a shortage of 3.2 million patient-facing healthcare workers (front desk staff, schedulers, etc.).
          • Healthcare worker burnout: The American Medical Association reports that 48% of U.S. doctors reported burnout in 2020, with other health professionals reporting even higher levels.
          • Costly errors in early-stage patient engagement: Claim denial rates have skyrocketed during the COVID-19 pandemic. The average claims denial rate has risen by 23% since 2016. Roughly 50% of denials stem from issues at the front-end patient engagement stage.ii
          • Disappointing financial performance: As operating costs and losses increase, lack-luster financial performance has followed for many medical groups.

According to Smith, the areas that offer the strongest opportunities for mitigating losses and improving revenue capture include:

        • Patient engagement process improvements
        • Deployment of automated AR optimization technology that reduces claim denials
        • Insurance verification process improvements and automation
        • Modified AR practices that help increase Medicaid reimbursement
        • Restructuring financial assistance policies and programs
        • Training front-end staff to better deal with payment issues

                  While medical groups often focus on back-end operations to improve operations and financial strength, the numbers don’t lie. Some of the biggest areas of opportunity for improving profitability and patient care are tied to improvements in the front-end patient engagement processes. In her webinar, Smith delved into strategies for seizing these opportunities and offered actionable recommendations for medical groups to implement changes. To learn more, watch the webinar recording:
Reducing the Burden of Patient-Facing Administrative and Revenue Cycle Tasks

i “US Healthcare Labor Market.” mercer.us, accessed 18 March 2022.
ii “The Change Healthcare 2020 Revenue Cycle Denials Index.” changehealthcare.com, accessed 18 March 2022.

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