Why Revenue Cycle Operations Are Ready for Change

When we talk about evolution in the realm of technology, that usually doesn’t do justice to the speed of change. As a biological imperative, evolution is measured across millennia; in tech, we’re seeing significant shifts across months, not years. If we’re talking about revenue cycle management in rehab therapy, however, waiting for systems and software to adapt to the environment has felt more like waiting for wings or a prehensile tail to sprout.  

Rehab therapists, and healthcare professionals more broadly, have had to watch other industries make leaps and bounds in how they manage their revenue streams, all while they’ve been stuck in a system that’s outdated by any measure. The reasons for that are complex, but the solutions emerging are making revenue cycle management as simple as in most other professions in the twenty-first century.  

Complexity begets complexity. 

It probably goes without saying, but healthcare is rather unique among businesses. Even calling it a business feels a bit off-putting, and certainly undersells the relationship between a nominative customer and their service provider.  It’s an ongoing relationship that often spans across months or even years, and it’s sat right in the heart of the most complex system humans could ever hope to devise, which is not meant as a compliment. 

Think about an (admittedly crude) parallel: the relationship between a car owner and a mechanic or repair shop. The rough contours are the same—something’s broken or requires maintenance to continue functioning, an expert plies their skill—but the process is so much simpler: the mechanic gives you the bill, you pay on the spot. 

Compare that to the process for a rehab therapy episode of care: the authorizations required before a patient even sets foot in the clinic, the documentation and coding needed to communicate to payers that yes, this person does require medical care and yes, the treatment being given is appropriate, the different rules that each of a half-dozen insurance companies put in place that you have to mentally cycle through with each patient. That’s before we even touch on the modifiers you have to use for disparate services offered at the same time or treatment provided by PTAs or OTAs, or the fact that you’re getting paid by a third-party that sort of works for your patient but really works for themselves.  

Now repeat this process every day for a growing number of patients, and you can see why managing billing and payment is the Herculean task that it is, and why it’s been so hard for the rehab therapy revenue cycle to keep pace with other industries.  There’s no way to disentangle treatment from the administrative and financial apparatus that’s been built on top of it, so the only way through is to better manage that complexity, to take all the composite pieces of care and build a clearer picture.     

Things are changing in revenue cycle operations.

Fortunately, technology is reaching the point where it can handle something as complex as RCM operations in healthcare and rehab therapy, in part by being able to learn from what the human experts are doing. Over enough time and instances, there are patterns that exist in how billers are dealing with claims, which claims get sent back and for what reasons, and how billers prioritize the work in front of them. 

Technology isn’t entering to change how the process works, but instead simply automating those high-level tasks and doing the work for them. It’s combing through all the claims to catch issues based on the rules that it understands, which are rules established by people who understand them. That shift frees up billers to spend more time thinking about the big picture issues — and maybe getting ahead of them.  

Practices need to shift from reaction to prevention. 

For most clinics, the immediacy of their daily crunch means that problems can’t be considered until they're problems, or put another way, they can’t worry about denied claims until they’re denied. It’s been the way they’ve operated for years, perhaps as long as the clinic’s been in existence, and as we all know, it’s hard to shift a long-standing habit — even if it’s one that creates more work in the end.  

Where this reactive cycle ends up is with teams ultimately fixing countless claims issues but never quite getting to fixing the root cause. It’s understandable with staffing stretched thin as it is, but it’s also a little short-sighted, as that extended strain on your team to fix claims in addition to their already maxed-out workload is going to lead to burnout. 

Practices need to sit down as a whole and figure out the source of repeated denials, rather than simply going about business as it’s always been. Fortunately, automation in the billing process gives billers the space to find the signal in the noise and determine where your overall operation is missing the mark in producing clean claims.  

Better billing makes business sense. 

You’d like to get your claims paid on time, right? And get paid in full more consistently the first time? Well, that’s the pitch for a billing process that helps billers out with automation. 

Granted, as compelling as that pitch might seem, it’s not always an easy one to sell to rehab therapy leaders. The reasons are many: change could just as easily be bad as it could be good, current processes aren’t perfect but work well enough, or it’s hard to justify the expense of another tool. Part of that is a skepticism that’s baked into the profession about change and technology overall, but that doesn’t mean there isn’t valid hesitance about altering existing operational workflows. 

In this case, change is good for your billers and your business. Getting ahead of billing issues prevents delays in getting paid, and more predictable revenue gives practices the ability to plan and forecast growth more confidently. More importantly, the ability to collect what you’re owed more effectively reduces the pressure to compensate for lost dollars by increasing productivity demands.     

It’s taken decades for rehab therapy RCM to get to the point where it can evolve to something closer to other industries. Don’t let the opportunity to make change in the profession — and in your clinic — pass you by. 

See how WebPT supports rehab therapy businesses by combining AI-assisted workflows with dedicated revenue cycle management services built specifically for PT, OT, and SLP clinics.