What We Do
Hospitals exist in a very uncertain time. Reimbursement risk runs high and receiving payments from patients is not guaranteed. The ability to capture lost revenue and improve the ability to forecast actual revenue received to the budget is necessary for hospitals' and other service providers' survival and vitality.
Here comes Revenue Cycle Management (RCM). This critical service improves patient accounting practices towards error free profitable billing, smart occupancy management, and economic utilization of hospital recourses.
Who We Worked With
Dar Al Shifa Hospital
New Mazloum Hospital
Al Hanan Hospital
Centre Hospitalier du Nord
Tri-C Academy Training Program
United Arab Emirates
GATES Presents An Array Of Services Related To RCM In Hospitals:
- RCM Diagnosis: a multi-perspective and multichannel holistic diagnosis of the scoped processes.
- Denials Analysis: analysis of the guarantors’ denials reasons and providing recommendations for preventing these denials.
- Structuring and Restructuring: a holistic approach for restructuring the organizational structure and process (24 steps) of the RCM in a Healthcare Organization, in addition to RCM staff job tasks revamping.
- Performance Indicators Dashboard: a one-stop monitoring tool for the revenue cycle management performance including input, process, and outcomes indicators that align with the organizational strategic plan. The scope for dashboard is people (staff and physicians), processes, and financial performance.
- Utilization Management and Studies: conduct onsite visits and desktop data capturing to determine the utilization rates of resources by measuring time and consumption.
- RCM Capacity Building for Staff & Healthcare Professionals.
Revenue Cycle Management Diagnosis
Diagnosing an area in the organization takes a multi-dimensional aspect. A team of experts will identify the gaps in an area through a multitude of evidence-based tools, that are adopted and adapted from different organizational development methodologies and put into a sequential and systematic process. The RCM Diagnosis service aims at identifying the gaps in this hospital area, analyze them and move to proposing solutions that include but not limited to; revenue cycle management training, process revamping, place requirements, information system requirements, hospital services improvement, hospital visibility recommendations, RCM case management, Physicians-Hospital Win-Win relationship, and so on.
- Staff Voice, through focused semi-structured interviews to get an input on the pain areas in the RCM. This tool is adapted from the Socio-Economic Approach for Management (SEAM).
- Patient Voice, through focused semi-structured interviews to understand the customer’s perception of the RCM.
- Competency Assessment for RCM related staff through the Competency Assessment Matrix, an adapted tool from the SEAM.
- Process mapping and flowcharting of the RCM related procedures, to identify the process gaps.
- Healthcare information system assessment through a structured tool designed by GATES to identify the HIS features and the extent of automation in RCM operations.
- Analysis of the found gaps, in a collaborative effort with hospital key staff.
- Analysis of the denials’ reasons.
Revenue Cycle Management Restructuring
In result of diagnosing the RCM in an organization, there might be a need to review, adjust and improve the current structure. GATES experts will work on the following perspectives to design or redesign the RCM structure in an organization: Purpose of operations, Products/services, Process requirements, Provisions needed, place requirements, and people requirements. All put in a systematic context to ensure the synergy of design.
- Designing the RCM departmental structure, purpose, and scope of operations, as part of the departmental process, purpose, and products design.
- Identifying the list of procedures and documenting the procedures in line with the RCM 24 standard steps, designed by GATES.
- Setting job descriptions in light with the new process structures.
- Identifying the system requirements and setting the business requirement documents.
- Proposing a modified design for the place, to fit the multitude of operations for the RCM.
- Assisting the organization in choosing the people to fit in the designed new positions.
- Preparing the implementation plan, in collaboration with the organization.
Revenue Cycle Management Performance Indicators Dashboard
RCM area is crucial to any healthcare organization; it is where a hospital collects its fees for the healthcare services provided. Therefore, monitoring the performance in such area is highly needed to control gaps, and reduce errors, which leads to reduced denials.
The Performance Indicators Dashboard groups a set of indicators that cover all of the 24 standard steps in RCM, and the utilization. The aim is to measure holistically the performance and moving to the actions. This dashboard is customized to each organization, based on the needs. GATES Group team builds Performance Indicators Dashboard in many hospital areas, and for many purposes: physicians management, RCM staff, holistic RCM performance, etc.
- Setting the indicators in collaboration with the hospital key staff.
- Preparing the requirements for automation and assisting the development team in building a fully automated dashboard.
- Monitoring the dashboard implementation and getting monitoring results accessible to hospital team.