A just over one-year-old revenue cycle management benchmarking tool has been working well for two early adopters of the framework, called the Revenue Cycle Management Technology Adoption Model (RCMTAM).
The Pennsylvania Mountains Healthcare Alliance (PMHA) and UC San Diego Health (UCSD) have used the model to gain more clarity on how their RCM operations are performing.
The RCMTAM helps us identify and prioritize end-to-end products that address gaps in our revenue cycle, said Nicole Clawson, vice president of finance and revenue cycle for PMHA. PMHA steadily advanced the deployment of such products across 35 community hospitals.
The integration of contract management and related opportunities has already shown benefits. For example, four of PMHA’s hospitals now report better reimbursement following efforts to address contract variances identified during the RCMTAM launch. Next PMHA will tackle point- of-service collections rates, clean claims rates and days cash on hand.
The RCMTAM was launched late in 2023 by two organizations, HFMAand FinThrive, a revenue cycle technology company. The RCMTAM is a peer-reviewed, five-stage framework that assesses operational performance and the maturity of RCM technology within a hospital or health system. The model aims to set new industry benchmarks and link technology adoption with financial outcomes.
A major shift
UCSD initially used the RCMTAM to show areas of revenue cycle operations that were both functioning well and identify where there was room for improvement. But then Mike Vigo, chief revenue officer at UCSD completely shifted his strategic plan for the organization’s revenue teams based on three RCMTAM findings.
- Accounts receivable (A/R) management was not performing at its highest levels and left some measurable room for improvement.
- Collection rate ratios were good but demonstrated room for improvement in timely follow-up and efficiencies.
- Coding and revenue integrity showed room for improvement through a large gap in charge capture, evaluation and management (E&M) coding and acuity levels, when compared to national averages.
Vigo used that information to improve performance across several key performance indicators (KPIs), producing improved metrics and dollar value gains.
Six questions to ask about revenue cycle technology optimization using RCMTAM
1. Which business problems should be solved first?
2. Can existing systems be optimized?
3. Who from IT leadership and staff are available to assist?
4. What outcomes can be achieved?
5. How is success measured?
6. Where does RCM automation fit within the broader context of digital transformation and automation for the organization?
