Challenge: Create standardized Improvement Opportunity Backlogs (using enterprise platform) to identify, categorize, analyze, and implement solutions across 7 revenue cycle product lines. These service lines included: Medical Coding, Core Denials, Authorizations Management, Remittance Tracking, Posting Integrity, etc.

Results/Outcomes:

• Standardized Improvement Opportunity Backlogs and Process across 7 RCM service lines

  • Implementation of standardized improvement opportunity backlogs and grooming process to effectively prioritize solutions enhancements across product releases

  Lessons Learned

  1. Creating and fostering a collaborative team dynamic as well as being equipped with the necessary tools will allow you to discuss, investigate, analyze, ask (these are critical) before deciding on improvements/solutions

  2. Don’t settle for delays or extra costs.

  3. In an Agile environment, Value is gold (well this holds true regardless)

  4. Root cause analysis and MVP are great tools/weapons

  5. Your team members are the experts, not you (Make every decision with them)

  6. When you or your team members don’t know what’s going on or are stuck, a subject matter expert (SME) is what is needed.

  7. An agile project will always need consistent feedback from the customer

Core Team: Data Scientists, Engineers, Management of RCM teams, Business Process Improvement Team, Customer Success, Account Management

Timeline: 16 weeks

Approach

Weeks 1-3: Define

Project Kick-off/Alignment

• Current State Assessment (how are teams currently analyzing, prioritizing, and executing solutions)

• What are current pain points, inefficiencies?

• Understanding Key Performance Indicators across RCM service lines (e.g classic yield, turnaround time, lead time, etc.)

• Project Charter

• Project Plan

Weeks 4-6: Measure & Backlog Build

• Stakeholder Interviews to understand platform needs

• Data Needs

  • Current process of conducting root cause analysis (across clients, payers, medical service lines, ICD-10 codes, etc.)

  • Net Promoter Score and Client Sentiment tracking

• Current State Process Maps (cadence, roles, responsibilities, platform overview)

• Understanding of centralized tracking needs (information, data points, updates to management, dashboard requests)

  Weeks 7-10: Backlog Development (Design)

  Rapid Improvement Event with Core Team

  • Current state (process maps, performance metrics, stakeholder Interviews)

  • Root Cause Analysis

  • Brainstorm Solutions

  • Impact-Effort Matrix

  • Action plan

  Week 11-16: Backlog Build & Grooming Best Practices (Improve)

  • Creating standard cadence and protocols for “grooming” improvement opportunity backlogs

  • Create standard operating procedures (SOPs), access permissions, tailored views based on role, trainings, and FAQ documents

  • Weekly check-ins with team to understand how backlog was being utilized

  • Further improvements and adjustments as needed

    Skills Used

  • Lean Six Sigma, Agile, Scrum, Smartsheet, Jira, Project Management, Excel, Powerpoint, Word, Data Analysis, Brainstorming, Root Cause Analysis, Impact Effort Matrix, Stakeholder Buy-in

High Level Revenue Cycle Management Process