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Why You Should Utilize External Staff for SNF Revenue Cycle Management

The operational issues facing skilled nursing facilities today have never been more challenging, exacerbated by the COVID pandemic that has elicited even more disruption and pressure. In particular, the necessity of maintaining a healthy, viable financial footing is driving many SNFs to evaluate more robust revenue cycle management capabilities. 

Recently, we commissioned an independent market research study to delve deeper into the range of revenue cycle challenges currently facing skilled nursing facilities. A total of 100 organizations were surveyed, with 60% of respondents being decision-makers regarding evaluation and selection of revenue cycle management solutions. Of the total number of those surveyed, half of those were C-suite level executives, and nearly one third were CEOs.

So, what did they find?

The Challenge of Cash Flow and A/R Days

When asked to rank the most challenging aspect of managing their cash flow and keeping A/R days in check, a majority of respondents (52%) cited the complexity of payer rules for reimbursement. 16% said having the necessary level of expertise, and 13% essentially expressed the same sentiment by stating inadequate staffing. Taken together these three topics were cited by more than eight out of ten respondents.

Utilization of External Staff

Respondents were asked to select any/all revenue cycle tasks they are addressing via the utilization of external staff. 70% of respondents indicated their organization is currently using an external staff to assist with one or more revenue cycle tasks.  In descending order of most- mentioned, the RCM tasks are:

  1. Bad Deb Collections – 15%
  2. Billing-Third Party – 11%
  3. Aged A/R Collections – 9%
  4. Managed Care Contracting – 7%
  5. Third-Party A/R Follow-up Including Appeals, Audit and Denials – 6%
  6. Medicaid Enrollment – 6%
  7. Best Practice/Process Improvement Consulting – 5%
  8. Billing and Collections – Private Payment – 5%
  9. Payer Authorizations – 3%
  10. Admissions and Referral Intake, Including Validating Insurance – 3%

The study also examined the relative influence of reasons for using outside assistance to handle RCM tasks. 37% of those surveyed cited complexity of managing payer contracts and reimbursement rules. Not far behind as an influencer, at 28% was poor revenue collections performance. And 18% again echoed concern over insufficient available staff.

What About Those Not Using External Staff?

A minority (29% of respondents) said they are not utilizing external staffing. Among organizations that would consider utilizing external resources, respondents indicated the top three most likely tasks to be addressed would be 1) Payer Authorizations, 2) Admission/Referral Intake, and 3) Managed Care Contracting. Following right behind the top three are 4) Bad Debt collections, 5) Best Practice/Process Improvement Consulting, and 6) Medicaid Enrollment.

Drawing Conclusions

The SNF industry is confronted with the growth of managed care plans, changing reimbursement models, rising costs of operations and downward pressure on margins that leave little room for internal revenue cycle initiatives. In this study, SNF leaders indicated that an overall shortage of on-staff revenue cycle know-how, ballooning managed care complexity, and several other reasons are causing them to go outside their own organizations for help. Our new Revenue Cycle Management Services team has a range of ready-made avenues for fiscal improvement. Our experts will provide a free SNF RCM assessment, and our services are contingency-based, meaning we only get paid when you do. We can show you how to accelerate cash flow, maximize collections, recover underpayments, reduce claims denials and increase profitability. Convinced yet?

If you’re looking for more information, or would like to discuss these findings further

February 16, 2021