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At its core, revenue cycle optimization is an intuitive concept to endorse. It makes sense that when your technology is updated and your teams are implementing best practices, that your organization will likely run smoother. The trickiest parts about optimizations are often the resourcing and the work needed on both the front and back end to make it successful.

So what can your organization do to help facilitate a successful revenue cycle optimization? Here are three key tips that should be top of mind:

1. Focus on KPIs (key performance indicators)

2. Enter an optimization mindset

3. Create an ongoing optimization culture

1. First things first: let's talk KPIs.

Standard KPIs to target

From a broad perspective, revenue cycle teams should prioritize the following key performance indicators (KPIs):

• Accounts receivable (AR) days

• Cash

• Discharged not submitted to payor (DNSP)

• Discharged not final coded (DNFC)

• Average daily revenue (ADR)

• Denial rate

• AR over 90

Focusing on the clinically driven revenue cycle

In addition to the standard KPIs above, it is strongly recommended that healthcare organizations focus on the clinically driven revenue cycle and automation of charges. A clinically driven revenue cycle (CDRC) uses information captured by clinicians during care to drive financial outcomes. A fully adopted CDRC aims to:

• Prevent redundant data entry

• Capture charges accurately

• Coordinate authorization requirements

• Predict financial obligations

From an optimization perspective, a focus on the CDRC is important because it can help accelerate cash and mitigate revenue leakage.

Baselining and identifying success measurements

Targeting KPIs is an important part of optimization, but establishing a baseline against which to measure improvement is equally important. By using baseline data to see where your organization stands from a historical perspective, you will have a clearer picture of your optimization's impact. However, not all baselines need to be in the form of standard KPIs – they could also measure other indicators such as manual charge entry.

2. Now, let's transition into entering an optimization mindset.

Continuous improvement

It can be tempting to take a step back from a project after improvements have been made, but dedicating effort to continuous improvement creates an optimization mindset that sticks. Continuous improvement should always be about strategically identifying ways to better your system and/or workflows. Some key continuous improvement questions to ask are:

• Where are the breakdowns and lost efficiencies?

• Where are the opportunities for improved efficiencies?

Optimizations should be crafted around specific, actionable goals (as opposed to simply listing things that aren't working). A helpful way to determine if your goal is specific enough is to consider the SMART goal framework. Keep your goals:

• Specific

• Measurable

• Attainable

• Relevant

• Time-based 

People, process, and technology

People, process, and technology are all important elements of optimization. Keeping all three in mind will help bring lasting results. One way to establish improvements in these key elements is for revenue cycle operations and IT teams to work together to:

• Determine operational KPI needs

• Demonstrate how the product/system can be used to reach the agreed-upon success metric

3. Finally, let's create an ongoing optimization culture.

Ongoing tracking

Ongoing tracking is key to creating an ongoing optimization culture. When you track regularly, you can more easily identify when results shift and better understand emerging trends. Training your teams to become proactive versus reactive can facilitate an ongoing optimization culture.

Tracking is important, but sharing the results of your tracking is just as important. Broadly distributing a KPI dashboard is a great way to share your success and show how everyone is accountable for the organization's overall financial success.

Creating a culture of action

One specific idea for creating a culture of action is to develop a revenue cycle action team. This is a team comprising revenue cycle and clinical leaders who have open discussions about how work within their respective areas contributes to financial metrics. These cross-venue discussions about KPIs can create a strong organizational culture and foster further understanding about the clinically driven revenue cycle.

We'll leave you with a saying that you've likely heard before – if you see something, say something. In other words, create a culture of action. The only way that issues can be addressed is when those working close to the issue speak up and act. And since end users often see the same issue over and over, the sooner it's addressed, the better. It's empowering for teams to be part of action and ultimately, a resolution.

If you are an Oracle Cerner client interested in enhancing revenue optimization, let our experts guide you through your next optimization and provide more context on the suggestions presented in this article. Learn more, contact us here.