3 ways rural health providers can increase financial stability

Financial health isn’t easy for rural health providers, with low patient volumes and Medicare rates making it challenging to generate revenue.

To have sustained financial health, your organization needs to ensure that all aspects of its revenue cycle are operating efficiently, allowing you to get the maximum rates and reimbursements for your services. And changing the way you invest in your people, view your processes and use technology can make it possible.

Here are three strategies your organization can use to increase revenue and improve your long-term financial stability:

1. Have the right staff in the right place

Rural healthcare continues to be impacted by a shrinking labor pool, with few qualified workers willing to relocate. However, having knowledgeable people in crucial positions throughout your organization can help your revenue cycle operate smoothly.

If you want to optimize your revenue generation, consider investing in these three key positions:

• Registration: Organizations tend to overlook registration, hiring low-skill workers and offering them low pay. But registration is not only the face of your organization, it’s also where the data that drives your entire revenue cycle begins. Placing experienced staff at your front desk can help you limit errors at this critical first step.
• Billing and coding: Coding for rural healthcare — especially rural health clinics and critical access hospitals — is complex, yet many rural providers leave this task to physicians. Having a separate department for coding provides the specialized knowledge that rural health organizations require, including understanding billing methodologies and payer mixes. It can increase your billing and coding accuracy, helping you optimize reimbursements.
• Payer contract negotiation: If you’re still letting your commercial payer contracts auto-renew, you’re leaving potential revenue on the table. Hiring an internal or outsourced negotiator can help you ensure that you’re getting the best possible contract. They can help you conduct necessary analysis about rates in your community and maintain a better relationship with your payers.

Finding talent

Rethinking how you invest in your staff can help you fill key positions, even with labor shortages.

Upskilling your current employees is one way to avoid the hiring process. Typically, staff in rural communities are people who have simply moved up in the organization over time — not necessarily people who have had proper training. Providing them with education and training helps you optimize your current staff while also providing them with opportunities for career development — an important factor in staff retention.

There are challenges with training: It can take multiple years and lots of additional work for a staff member to have a full understanding of complex concepts such as payer matrix. However, having staff who are well versed in the needs of their position can result in decreased errors and increased productivity across your revenue cycle.

Another option is to consider a remote workforce. Some rural organizations aren’t willing to allow remote work due to the loss of oversight and the fact that there are still paper-based processes in healthcare.

But the benefit is that you gain access to specialized workers who wouldn’t have otherwise considered working in rural environments. Flexibility is also quickly becoming a competitive differentiator amongst employers, giving you an edge over other healthcare organizations.

And your organization won’t need to move all your back-office staff to remote work. Instead, you just need to focus on certain positions. For example, you can split your billing and coding team between on-site and remote work, or you can use remote workers to handle collecting registration information for new patients before their appointments.

2. Understand your processes

Visibility into your revenue cycle processes can help your organization make informed decisions about how to improve your overall financial stability. But gaining that insight can be challenging since the processes involved span from registration to adjudication.

To better understand how your organization is managing the revenue cycle, try implementing:

Staff education

Each step in your revenue cycle leads directly to the next, yet in many rural health care organizations, staff may not even understand what the revenue cycle is. They only see their tasks and not how those tasks can impact others further along the cycle.

When staff can see how their piece functions in the revenue cycle as a whole — and how errors can lead to exponential problems later — they’ll be better able to fulfill their role effectively.  

It’s also important to train your staff to identify and flag the root causes of claims denials.

Root cause analysis

Practices such as root cause analysis help you dig deep into each step of the revenue cycle, making it easier to identify bottlenecks, errors and other inefficiencies at their source. And once you pinpoint the root causes of your revenue cycle challenges, you can apply targeted solutions to address those issues directly.

For example, an analysis may reveal that your organization consistently gets denied by a specific insurer due to coding errors or poor documentation. From there, you could analyze the workflows in your coding department to see whether solutions such as staff training or changing your documentation processes could prevent future denials and help improve your cash flow.

Tracking

Tracking productivity across the revenue cycle is an important tool for helping your organization evaluate overall financial performance.

For greater visibility into your revenue cycle, your organization can track:

• Standards: Setting standards for productivity will help you better track performance in key departments. To set your standards, start with your staffing matrix. For example, in your coding department, you would need to understand your volume, the types of coding required and best practice statistics from similar facilities.
• KPIs: Tracking KPIs — such as denial rate, rejection rate and average days in accounts receivable — will help you determine whether your processes are operating efficiently and standards are being met. Adding KPIs to your daily work will help you drill down so that you can measure your productivity even at the level of individual staff members.

Claims analytics

Dynamic data gathering and analysis is essential for gaining insight into claims processing and trends.

Claims analytics takes your data about claims results — whether they were accepted, rejected or denied — and helps you identify crucial trends. It provides valuable information on denials, including breakdowns by type and payer, to help you pinpoint denial causation.

With relevant, valid data, your organization can also better identify problems in your reporting processes and implement effective solutions.

3. Be strategic with your technology

Adopting new technology effectively can help your organization increase efficiencies and revenue.

Rural providers are facing historically low margins, higher denial rates and labor challenges. Building up your technology foundation and investing in innovations like AI and modern analytics can help you reduce financial and labor strains while helping you achieve greater revenue cycle efficiency.

But if your organization isn’t ready to invest in upgrades, you can focus on building knowledge of the systems you’re currently using instead.

Training and education about your tech can help you identify what your stopgaps are, as well as the workarounds that are available to you. Once the people in your organization understand the limitations and how you can overcome them, you can start getting your technology to work better for your needs.

This saves you the capital needed to invest in a new system while increasing your ability to use your current technology to reduce errors and improve your revenue cycle management.

How Wipfli can help

Wipfli’s nationwide team is ready to provide your organization with the solutions it needs to keep delivering high-quality care. We can provide guidance for all aspects of the revenue cycle from helping you hire and train talented staff to finding and optimizing the right technology solutions.

Contact us today to learn more about how we can help your organization improve operations and achieve financial health.