Cheryl Cruver, Chief Revenue Officer, AGS Health

Exacerbated by pandemic-induced burnout, resignations, and even terminations1, chronic coding and revenue cycle management (RCM) staffing shortages have healthcare organizations struggling to find ways to keep revenue flowing despite a lack of qualified professionals to handle critical processes. It is a situation that has been brewing for years, as too few qualified professionals are entering professions that are expanding more rapidly than ever before.

According to the American Hospital Association (AHA), medical records, billing, and compliance are the fastest growing healthcare white-collar administrative professions, expected to grow 13% by 20262. Further, the Bureau of Labor Statistics (BLS) projects that the number of medical record specialists and coders will increase by 9% from 2020 to 20303.

The Rising Cost of Desperation

The worsening shortage and resulting short- and long-term impacts put addressing staffing challenges at the top of priority lists for many health information management (HIM) directors, revenue cycle leaders, and CFOs whose organizations are already under extreme financial pressure and facing greater regulatory uncertainty and audit scrutiny4. Across all healthcare jobs, the turnover rate has risen by almost 5% over the last decade5, contributing to longer times to bill and reimbursement delays, plus rising recruitment, onboarding, orientation, and retention costs. 

The Commonwealth Fund says that a quarter of hospital expenditures (~$215 billion) comes from administrative costs like marketing, administration, and salaries for employees responsible for coding and billing6. Greater competition brings higher recruitment costs, which already equal about 20% of a coder’s salary. 

Desperation to fill staffing gaps can often lead to the “warm body syndrome” method of hiring7, which can only add to the damage – and expenses – in the long run. A smarter strategy focuses on optimizing the productivity of existing teams to avoid burnout by adopting a hybrid approach blending outsourced services with technology, augmenting internal teams with outsourced coders and a substantial focus on automation wherever possible. 

Such an approach can improve revenues through increased collections, reduced delays, and denials, and fewer days in accounts receivable8. For example, outsourced partners are in a better position to identify problems in coding that contribute to higher denials rates and offer insights into how those issues can be resolved before they impact the revenue cycle, not to mention scalable resources to meet patient volumes, workloads, bottlenecks and allowing internal staff to focus on value-added tasks.

The Technology Factor

Technology, specifically artificial intelligence (AI) and automation, improves speed and accuracy and optimizes processes while freeing internal resources to focus on core coding and RCM responsibilities. As a result, internal across-the-board manhours are also reduced, as are costs associated with training and continuing education. For example, low-skill, repetitive tasks that don’t require critical thinking skills are prime for automation. In addition, AI and automation can support back-end RCM processes like claims scrubbing, identifying patient self-pay amounts, and alerting patients to amounts due and electronic collections. 

Comprehensive data analytics software can perform deep dives to deliver visibility into crucial organizational metrics. One Florida hospital automated patient collection notifications and increased collections from the high teens to about 43%9. A Texas practice saw its A/R over 60 days drop by 38% just three months after deploying an automation solution10

Additionally, automation can reduce the need for review and query management and eliminate the need for spreadsheets. Further, advanced computer-assisted coding (CAC) now leverages AI …….

Source: https://hitconsultant.net/2022/08/03/overcome-coding-rcm-staff-shortages/

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