The 5 R’s of Revenue Cycle
Much of healthcare delivery revolves around providing the right care to the right patient at the right time. You’ve probably heard of the 5 R’s of administering medication: right patient, right drug, right time, right dose, and right route. In this case, adhering to a time-honored and tested process ensures patient safety and effective treatment.
Much like patient care, this type of framework can be applied to the business of healthcare revenue cycle. Guiding principles to effective revenue cycle management (RCM) exist and can be broken down into 5 R’s as well. Each of the 5 R elements must be balanced and work in sync to reduce inefficiencies and overcome roadblocks.
Revenue cycle success isn’t about simply following steps. It’s about making sure that the:
1.) Right claim
(claims are categorized by value and accuracy)
Is addressed at the
2.) Right time
(a workflow automation tool ensures that the highest value and most time-sensitive claims are prioritized)
And handled by the
3.) Right person
(the claim is assigned to the right team member with the right expertise to handle the complexity of the claim within payer specific guidelines)
Who takes the
4.) Right action
Which results in the
5.) Right payment
If this sounds like common sense, that’s because it is. Good RCM starts with nailing the basics and setting the right work strategy for A/R, making sure that strategy is followed by employees, ensuring every employee takes the correct action on a claim (regardless of their level of experience), and ensuring this happens efficiently. Technology can help move things along and automate parts of the process, but human intervention is still necessary due to the complex nature of some claims. Revology has a deep understanding of RCM and we know how to set clients up to do the basics really well.
Revology’s approach is to align every step of the 5 R’s with a strategy and real time visibility into its effectiveness. At the core of this strategy is Auxo, Revology’s SaaS solution, which simplifies the insurance follow-up process and provides transparency with workforce management. Bolstered with analytics to monitor outcomes and tweak workflows in real time, Auxo ensures the right person is assigned to the right claim at the right time to take the right action and receive the payment.
By bringing together the power of automation with the expertise of skilled professionals, healthcare organizations can ensure that the 5 R’s don’t just exist as a framework—they actively reduce stress, keep operations running more smoothly, and drive financial success.