Strategic Tips for Aligning Case Management and Revenue Cycle
Case managers have a challenging, high-stress job, but there’s one department that should always be on their side, and that’s revenue cycle.
Revenue cycle success can have serious benefits from integrating case management into all five phases of acute care — meaning any financial leader interested in driving optimal outcomes should look for opportunities to support case management in their work. Here are five ways you can start advocating for case management in your organization.
1. Fight for Their Representation
Case management is a vital department, especially in the age of value-based care. But unfortunately, they’re still frequently left out of key organizational discussions. Case management offers unique resources, perspectives, and experiences, so support from a department like revenue cycle can help in getting their voices heard. The great thing is their increased representation is a win-win for your department. Consider their work in health plan contracting and their relationship with managed care departments. Their daily contact with payers can be a valuable resource for revenue cycle leaders who benefit from deeper insight into health plan practices that might be dragging down revenue cycle results.
2. Invest in Their Education
While the potential symbiosis between case management and revenue cycle might be obvious to you, the same might not be true for them.
While case management leaders are aware of the role they play in optimizing value-based care contract outcomes, they could probably use some support to understand what that looks like from a revenue cycle perspective.
RCM should collaborate with case management leaders to identify training deficits and areas where they could use support in understanding their impact on revenue cycle results. Make sure to include a focus on technology and how case management and revenue cycle systems align. Consider identifying best practices for case managers to ensure mutual benefits between the two departments.
3. Advocate for Their Funding
As with anything else in the hospital environment, you won’t see results without proper funding. Revenue cycle leaders should position themselves as ongoing support for case management budgets, making sure they’re receiving the funding necessary for updated training, software, and technology that improves their overall efficiency. Small boosts in their budget can help them improve productivity around payor clinical reviews and help managers maintain optimal focus in utilization management.
4. Discuss Denials
If there’s any area where case managers can return the favor of revenue cycle support, it’s denials management.
Medical necessity denials are a delicate dance between case management, coding, and billing. If you aren’t working together, you’re likely seeing the impact in your denials-related KPIs. If you’re currently having this issue, evaluate whether case management understands denials and appeals processes, and how their work and decisions trickle down through the revenue cycle to impact cash flows. Strong utilization management programs can be highly effective in reducing denials.
5. Help Them Find a Physician Advisor
If case management isn’t taken seriously in your organization, check whether the department has an effective medical director or physician advisor. This title can lend some credibility to the department and grease the wheels of other relationships.
Physician advisors can be a powerful support system during a utilization review that involves patients who don’t meet acute care criteria but still need communication with a primary care provider to resolve an issue. CFOs especially can aid in allocating resources to recruit and hire qualified advisors or directors.
While most of your work lobbying for case management will involve human connection, your relationship can be aided by the technology solutions you choose. Make sure the revenue cycle solutions at your organization facilitate tailored conversations that blend seamlessly into the communications your case management department is already using and can empower them to better understand the patient perspective.
This article was originally published on RevSpring and is republished here with permission.