A bottleneck is a situation that causes delay in a process or system. It is that place in your revenue cycle that slows everything down. It delays cash flow for your practice and harms your revenue cycle outcomes.

Bottlenecks are sometimes difficult to recognize and remove. Common reasons for ignoring bottlenecks are that “it’s always been this way,” or “that just takes more time.” While the temptation may be to stick to the status quo, there is always room for improvement in your revenue cycle. Working out the bottlenecks in your revenue cycle will increase productivity and boost revenue cycle outcomes.

Many practices mistakenly throw more people at the problem, rather than resolving the root cause of the problem. Save yourself from over-hiring by identifying bottlenecks, finding the root cause of the bottleneck, and resolving the bottleneck with a more efficient solution.

Common Revenue Cycle Bottlenecks

Coders Who Review Every Encounter

One major bottleneck that most practices don’t even recognize occurs during the coding process. Coders who review and touch every single encounter are actually slowing down the whole process. This is a difficult problem to catch, because for one thing, your coders are excellent at finding and correcting coding mistakes. They are doing a great job at making sure every claim that goes out the door is complete and correct. The problem is that reviewing every encounter slows the coding process down so that the money they are saving you by catching errors is actually not worth the cost.

The solution to this bottleneck is to implement an exception-only coding workflow. This allows custom rules to do the work of searching for encounters with errors. Coders who only review encounters with errors will be much more productive, and custom rules will catch the same errors that they were manually resolving. Coding productivity will increase by 2-3x what it was before, and the bottleneck will be resolved.

Lack of Closed-Loop Denial Process

Another area where your revenue cycle process can experience bottlenecks is in denial management. Many practices have departments that do not effectively communicate. Often the staff members in charge of following up on denials do not communicate those denials back to their coding staff. If coding staff are never told about changes in insurance company policy that could lead to denials, the denials will continue for a lot longer. 

This bottleneck can be resolved by establishing a closed-loop denial process. In this process, the people who follow up on denials take note of the cause of the denial. They can then communicate this to the coding staff, who are able to build a new custom rule. Going forward the rule will catch the potential denial-causing error, which they can then change. There is no need for duplicate denials that are a waste of time and money.

Rules Fatigue

Finally, another area that can cause a revenue cycle bottleneck is rules fatigue. Custom rules are extremely helpful, but only when they are written correctly. Rules fatigue occurs when custom rules are firing that coders are ignoring. As a result, they are viewing so many rules that they may actually miss the one they really needed to act on. There may be a rule that fires regularly, and the coders ignore it 75% of the time. 25% they actually do need that rule in order to make a change on an encounter, but it is causing them to stop on more encounters than is necessary.

The solution is to adjust your custom rules. Make sure you are building rules that actually benefit your coding team. Rules should fire only when the coder actually needs to make a change. This is why continually reviewing rules and looking for new rules opportunities is an important part of a healthy revenue cycle workflow.

For more information about our rules engine and code scrubbing software, AccelaSMART, click here.