But is it worth the investment in staff education? “Organizations that devote time and resources to staff education perform at higher levels and have better revenue cycle metrics,” affirmed Richard L. Gundling, senior Vice President of Professional Practice at the Healthcare Financial Management Association (HFMA).
Training can be provided in various ways — web-based or in-person, printed or digital. Gundling recommends each department find the right methods that work for their team. ROI of revenue cycle education
Revenue cycle staff with the skills to do their jobs well are likelier to take ownership and pride in their roles. “That translates to more than dollars for an organization,” said Abby Behm, Director of Revenue Cycle Academy at Stanford Health Care.
Higher performance quality
Investing in revenue cycle staff training can lead to decreased denials and cleaner claims, providing quantitative, revenue-based benefits for your organization. There are also qualitative benefits, such as fewer billing complaints. “One of the most impactful benefits of a quality training program is increased employee engagement,” said Amy Hayes, Senior Director of Revenue Cycle at Great Plains Health.
While entry-level employees need additional education to do their job with confidence, experienced employees can also benefit from continuing education by developing their revenue cycle expertise beyond basic knowledge. Better retention
According to an MGMA Stat poll, as many as 58% of medical practices face staffing as their biggest challenge in 2023. “Turnover and new hires in positions ranging from front desk to billers, coders, and collections often lead to revenue cycle errors and upfront denials,” said Andrew Hajde, CMPE, Director of Content and Consulting at MGMA.
Employees who are well-trained and confident in their roles are more likely to stay in their positions. With staffing at the forefront of everyone’s minds this year, it is more important than ever to focus on the retention and development of your current staff. Top 10 revenue cycle training priorities with the best ROI
As previously mentioned, the healthcare revenue cycle is complex. You may be wondering where to even start with your staff. Here are the top educational priorities for 2023 as identified by revenue cycle leaders…
1 – The basics of submitting a “clean” claim
“Doing it right the first time minimizes do-overs,” said Pete Kraus, CHAM, CPAR, FHAM, Business Analyst for Revenue Cycle Operations at Emory Hospitals in Atlanta.
2 – Financial consequences of registration errors
Kraus also recommends managers review the accuracy of the coding and billing process to ensure that all claims are submitted correctly. Additionally, staff should be trained on the importance of accuracy when submitting claims and how to identify potential errors. Finally, managers should also review the accuracy of the coding and billing process to ensure that all claims are being submitted correctly.
By taking these steps, staff members can be better informed and more confident in their ability to submit accurate claims and avoid costly denials. 3 – Updates to payer requirements
“Requirements are changing rapidly with the multitude of payers,” said Hayes. The financial health of an organization rides on understanding these changes and ensuring staff is educated supports accuracy.
“It’s hard even for experts to keep up. Some payers are deliberately capricious,” said Kraus. Some health plans refuse to pay claims if supporting documentation for a procedure is missing. Some EMR systems warn staff when critical payer requirements are missing (such as prior authorization). In these cases, staff can make the necessary edits before the claim is sent out and potentially avoid a denial. Additionally, managed care specialists, denial specialists, and information services staff can support physicians and coders alike to avoid facing these issues. 4 – How to help patients needing financial assistance
In addition to understanding the regulatory changes in the industry, revenue cycle staff members need specialized financial training to assist patients with an entirely different aspect of care. “This alleviates some of the patients’ anxiety,” said Lora Redden, Senior Director of the Patient Financial Experience at Texas Health.
5 – Denial prevention and management
"Revenue cycle specialists should have a clear understanding of the appeals process and be prepared to act quickly if a denial does occur. They should also have a system in place to track the progress of appeals and ensure that all claims are followed up on in a timely manner. As Hayes noted, 'It's not enough to simply submit clean claims. You need to make sure that you are actively following up on those claims to ensure that they are being processed correctly.' Organizations can maximize their revenue by having well-trained staff and efficient follow-up processes in place and ensure that their claims are being processed correctly."
6 – Post-pandemic changes
Staff members who are new to healthcare (or new to the organization) must be educated about temporary leniencies that were granted during the COVID-19 public health emergency (PHE) — and which practices are now being rolled back to pre-pandemic standards.
7 – CPT® Evaluation and Management code and guideline changes
Codes must be documented accurately to obtain appropriate reimbursement. The Centers for Medicare & Medicaid Services (CMS) releases final rule updates annually for hospital outpatient prospective payment systems (HOPPS) and Medicare physician fee schedules (MPFS). Codes changed in 2023 for emergency, observation, and inpatient hospital services. “This will require additional education for coders, clinical documentation integrity teams (CDI), and providers,” said Hayes.
8 – Best practices from the revenue cycle field
Your staff needs education beyond just the revenue cycle. “Industry knowledge can ignite innovative minds,” said Hermosillo. That is why it's important to keep your staff up to date on daily operations and industry best practices. For example, Hermosillo's department covers the cost of staff to attend approved conferences and networking events, as well as reimburses staff for obtaining certifications from HFMA, National Association of Healthcare Access Management, and the American Health Information Management Association.
Revenue cycle staff members then share that additional knowledge with colleagues to spark conversations about opportunities for improvement. “This can lead to some impressive wins,” said Hermosillo, highlighting her department's recent developments in automation which resulted in operational improvements. 9 – Critical thinking skills
More automation incorporated into the revenue cycle means simple tasks will require less (if any) human intervention. This will allow staff to spend more time on complex tasks requiring critical thinking and problem-solving skills. Additional "soft skill" education may be beneficial to support your team in this new direction.
10 – A comprehensive understanding of the revenue cycle
“We have seen the most ‘bang for our buck’ in overarching revenue cycle training,” said Behm. Each staff member has the opportunity to learn how their tasks affect the next person’s job and contributes to the organization's revenue. Comprehensive education fosters a holistic understanding of the healthcare revenue cycle process.
How to prioritize your staff education
Understanding where to begin can be daunting. Along with the priorities mentioned here, RCCS can perform a revenue cycle performance evaluation to pinpoint the largest opportunities for operational improvements and training.
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