Readers Write: Unlocking Hidden Gems: Leveraging RCMTAM for Revenue Cycle Excellence

Unlocking Hidden Gems: Leveraging RCMTAM for Revenue Cycle Excellence
By Kim Waters

Kim Waters, MBA is principal consultant, advisory services with CereCore.

Revenue cycle management (RCM) has become more challenging than ever. With increasing denials, evolving payer policies, and growing patient financial responsibility, healthcare organizations need innovative solutions to optimize their revenue cycles. Enter the Revenue Cycle Management Technology Adoption Model (RCMTAM), a game-changing framework that’s revolutionizing how we approach RCM technology.

As a leader in healthcare IT solutions, I’ve seen first hand how RCMTAM can transform revenue cycle operations. Let’s dive into the hidden gems this model offers and explore how it can drive operational efficiency, improve financial outcomes, and uncover cost-saving opportunities.

The RCMTAM Advantage: A Data-Driven Approach to RCM Excellence

RCMTAM is more than just another acronym in the healthcare alphabet soup. It’s a peer-reviewed, five-stage framework endorsed by Healthcare Financial Management Association (HFMA) that assesses operational performance and the maturity of revenue cycle technology within healthcare organizations. What sets RCMTAM apart is its data-driven approach, linking technology adoption with financial outcomes to create customizable roadmaps for RCM optimization.

Key features of RCMTAM include:

• A five-stage model for assessing RCM technology maturity.
• Financial benchmarks for performance comparison.
• Correlation of RCM technology adoption to financial performance.
• Personalized organizational roadmaps.

Uncovering Hidden Gems: RCMTAM in Action

Let’s explore some specific examples of how RCMTAM can enhance operational efficiency and improve financial outcomes:

• Streamlining eligibility checks. Experian’s recent state of claims survey revealed that 43% of respondents spend 10 to 20+ minutes on secondary eligibility checks. By leveraging RCMTAM to assess and optimize eligibility verification technology, organizations can significantly reduce this time, improving staff productivity and accelerating the revenue cycle.
• Tackling denials head-on. With 38% of respondents reporting claim denial rates of 10% or higher, denials management is a critical area for improvement. RCMTAM can help organizations identify and implement advanced denial prevention and management technologies, potentially saving millions in denied claims.
• Automating manual processes. Nearly 50% of providers still review denials manually. RCMTAM can guide the adoption of AI and automation technologies in the denial management process, freeing up staff for more complex tasks and reducing errors.
• Enhancing data accuracy. Bad data is a leading cause of denials, with 46% of respondents citing missing or inaccurate data as a top reason. RCMTAM can help organizations assess and improve their data management technologies, reducing errors and improving clean claim rates.

The Path Forward: Embracing RCMTAM for Continuous Improvement

As the 2024 State of Claims survey shows, the healthcare landscape is constantly evolving. Payer policy changes are occurring with more frequency (77% agree), and 66% of respondents find submitting “clean” claims more challenging now than before the pandemic. In this dynamic environment, RCMTAM provides a structured approach to continuous improvement.

By regularly reassessing your organization’s position on the RCMTAM scale, you can:

• Identify emerging technologies that address your specific pain points.
• Benchmark your performance against industry leaders.
• Create data-driven strategies for ongoing RCM optimization,

Navigating the complexities of revenue cycle management can be tough. An RCMTAM assessment can provide the performance readout that your organization may need to help uncover the hidden gems in your revenue cycle so you can drive meaningful improvements in your financial performance.

As you embark on your RCMTAM journey, remember that technology is just one piece of the puzzle. Success lies in the seamless integration of people, processes, and technology. By taking a holistic approach and leveraging the insights provided by RCMTAM, you can transform your revenue cycle from a source of frustration to a driver of organizational success.