Streamlining Revenue Cycle Management with Value Stream Mapping
Healthcare
Case Overview.
Efficient revenue cycle management is critical in the healthcare sector, directly impacting operational efficiency and financial health. A top healthcare provider partnered with Pegasus One to identify and implement process improvements to optimize their revenue cycle. By leveraging Value Stream Mapping (VSM) alongside workshops and data-driven methodologies, we developed a tailored solution to address key business challenges and achieve measurable results.
Lean Six Sigma, Business Analytics, Automation, Value Stream Mapping
Challenges.
The client faced multiple operational inefficiencies that hampered their revenue cycle performance:
- Prolonged Collection Times
- Lengthy processes delayed the collection of payments on claims, impacting cash flow.
- Inconsistent Claims Documentation
- Incomplete or incorrect documentation by sales personnel led to delays and denied claims.
- Lack of Metrics for Performance Tracking
- The absence of a structured system for tracking and managing key performance indicators hindered long-term improvement.
- Training Gaps
- The sales team lacked comprehensive training to handle claims documentation and revenue cycle nuances effectively.
Our Approach.
To address these challenges, Pegasus One designed and implemented a strategy rooted in process excellence and data analytics:
- Value Stream Mapping (VSM)
- Conducted VSM workshops with key stakeholders to identify bottlenecks, waste, and opportunities for improvement across the revenue cycle.
- Performance Scorecard Development
- Created a custom performance scorecard for the sales staff to monitor and evaluate their contributions to the revenue cycle.
- Documentation Template
- Developed a standardized template to ensure complete and accurate claims documentation, reducing errors and delays.
- Sales Team Learning Program
- Designed and delivered a targeted learning program to upskill the sales team, equipping them with best practices in claims management and revenue cycle optimization.
- System Enhancements
- Upgraded the client’s claims system to include:
- Key Metrics and Control Measurement System: Enabled real-time tracking of performance indicators.
- Enhanced workflow and ordering procedures: Streamlined processes for improved efficiency and compliance.
- Upgraded the client’s claims system to include:
Results Delivered.
The implementation of Pegasus One’s solutions produced transformative outcomes for the client:
- 33% Reduction in Collection Times
- The average time to collect on claims was significantly shortened, improving cash flow.
- 18% Increase in First-Time Finalization
- More claims were finalized correctly on the first submission, reducing rework and delays.
- Higher Billed Claims Value
- Improved documentation and processes led to an increase in the total value of billed claims.
- Long-Term Sustainability
- The integration of metrics and control systems ensured ongoing performance improvements and operational stability.
Value Delivered.
Through tailored process improvements and system enhancements, Pegasus One empowered the client to:
- Expand Operations: Achieve scalable growth while maintaining process efficiency.
- Lower Resource Requirements: Reduce operational costs through streamlined workflows.
- Improve Team Effectiveness: Elevate sales team performance through targeted training and better tools.
Conclusion.
By combining advanced methodologies like Value Stream Mapping with a focus on automation and data-driven insights, Pegasus One helped the client transform their revenue cycle management. This project not only delivered immediate financial benefits but also ensured long-term operational resilience.
