Revenue Cycle Workflow Systems

It’s common to have multiple workflow systems for your revenue cycle front and back offices. As a leader in technology-driven revenue cycle management (RCM), Prochant has talked with a lot of home-based care providers over the decades. We know a thing or two about workflow solutions and how to optimize them!

Unless you build it yourself, there is really no single unifying workflow system or “one system to govern them all.” Instead, providers typically leverage what are called “WIP states,” or work-in-progress states, to manage their front office and order-flow. In the back office, these providers leverage one or more different systems to manage the revenue cycle workflow.

Here’s an example of common front-office RCM workflow queues:

These are examples of common work-in-progress (WIP) states. In addition to the WIP state, each work item also has an owner and follow-up date.

• 1.0 New Intake
  • 1.1 Missing Information
  • 1.2 Qualification Issue
• 2.0 Benefits Verification
  • 2.1 Benefits Issue
• 3.0 Prior Authorization
  • 3.1 PA Requested
  • 3.2 PA Denied
• 4.0 Scheduling
  • 4.1 Scheduling Issue
• 5.0 Out for Fulfillment
  • 5.1 Fulfillment Issue
• 6.0 Ready for Billing
  • 6.1 Billing Issue

Cover your bases when you design your back-office RCM workflow, ensuring that you haven’t left gaps where work can fall through and get lost or missed.

Here’s an example of common back-office RCM workflow queues:

1. 1. Confirmation (managed through WIP states)
   2. Unbilled / Held / Stopped Revenue
   3. Claims Rejections (typically managed via your claims clearinghouse)
   4. Open Deposits (your Cash Posting queue)
   5. Billed Claims (or your Open A/R)
      1. To set up this workflow, some providers go with a green, yellow, and red color status in claims. This way, staff know which is a higher priority claim (red) based on information, such as aging bucket, timely filing limit, and average time to payment.
   6. Denials
   7. Follow-ups
      
      

Does that look similar to your own back-office workflow system? If not, it might be time to evaluate your processes. Unless you develop your own, you are probably going to have multiple workflow systems. This is not necessarily a bad thing. Make sure you’ve thought through every workflow system and that your staff can follow along.

To explore modern billing and reimbursement solutions, contact us today or you can reach out to Prochant’s Chief Revenue Officer Joey Graham directly at (980) 999-4293 or email joeyg@prochant.com. Find out how Prochant can help simplify your business!