8 Essential Elements for Financial Integrity and Visibility in Your RCM Data

Healthcare providers face unique challenges in financial reporting, data visibility, and analysis. With reimbursement complexities, changing billing requirements, and timely delivery pressures, organizations can struggle to report revenue accurately, track potential revenue leakage, and forecast cash flow. These challenges create potential risks of erroneous reporting, audit vulnerability, and missed deadlines while taxing accounting resources.

Managing a profitable healthcare business requires stakeholders to have timely and accurate financials to make better decisions. The ability to expertly manage accounts receivables with complete transparency and financial integrity is more crucial than ever to realize this goal. Healthcare providers, particularly those publicly traded or planning to go public, require a revenue cycle management (RCM) partner that understands the intricacies of commercial billing and maximizing reimbursement but also one that offers robust data visibility and financial integrity. This ensures accurate financial forecasting, audit preparedness, and precise period-end corporate financial reporting.

Financial visibility and integrity are foundational to a sound RCM strategy. Providers need an RCM partner capable of delivering monthly financial closing packages with data validated throughout the RCM process. This allows the organization’s Financial Planning and Analysis (FP&A) teams to trust the accuracy of the data and quickly drill down to see precisely what data was included in the calculations. This level of detail is essential for accurate forecasting and ensuring that month-end reporting balances to the penny with 100% reconciliation.

The following are 8 essential elements for financial integrity and visibility in your RCM data:

1. Comprehensive End-of-Month Financial Packages
   Complete end-of-month close accounting package, which includes a comprehensive set of reports for financial reporting as well as process and operational analysis, is essential to maintaining financial visibility and integrity. XiFin RPM provides monthly financial packages that consist of thoroughly validated data. For example, the system automatically validates payor IDs and CPT codes to ensure that accession and encounter data is accurate from the start. This enables healthcare organizations to analyze data at the payor and plan level, ensuring every financial metric is accurate and traceable. FP&A teams benefit from real-time and point-in-time reporting, giving them the tools needed for period-end corporate financial reporting and accurate forecasting.
2. Audit-Ready Reporting
   Ensure your organization is audit-ready with reports that uphold financial integrity and address unique financial nuances of healthcare reimbursement, including retrospective analysis of prior periods. XiFin delivers GAAP and SOX-compliant financial data that is general-ledger ready. This includes a complete financial accounting package, allowing providers to track billed amounts and compare them against expected payments and actual payments. This detailed information supports analysis, auditing, and reporting needs, providing a clear audit trail for each claim.
3. 100% Reconciliation Policy
   A 100% reconciliation process requires monthly reconciliation to the penny, which provides visibility to identify problems and rectify them as quickly as possible. XiFin’s policy of 100% reconciliation ensures that all data balances entirely at the end of each month. This rigorous approach takes full advantage of electronic submissions, acknowledgments, and remittance advice to identify and rectify issues swiftly. The Electronic Data Interface (EDI) team at XiFin works directly with payors and clearinghouses to resolve denied claims, maintaining data integrity and financial accuracy.
   
4. Valuable Managed Services
   Keeping your RCM process optimized and updated with the latest payor edits, data logic, regulatory compliance requirements, and industry best practices is a painstaking process and, if not effectively managed, can leave you vulnerable to errors or omissions. XiFin manages these elements as well as ongoing updates to ICD-10 and CPT codes, fee schedules, and other essential data points, ensuring the RCM process remains optimized and up to date. XiFin also loads and maintains Medicare expect pricing schedules.
   
5. Empowering and Supporting Finance Teams
   It is important to regularly monitor your RCM data to uncover new, actionable insights. XiFin employs financial analysts to help customers interpret data correctly, making the jobs of healthcare providers’ finance teams easier. The platform performs continuous checks and balances, validating all data throughout the RCM process.
   
6. Cloud-Based Business Intelligence Reporting
   Healthcare data, particularly medical and billing data, is especially complex, and the XiFin BI data model is specifically designed for this environment. XiFin’s cloud-based Business Intelligence (BI) platform is built on a world-class infrastructure that is powerful enough to handle FASB and other reporting requirements. XiFin BI allows users to drill down into data, answer complex accounting questions easily, and see metrics such as collection rates, aging, and other important trends over time. The platform provides the necessary tools for comprehensive financial analysis, supporting internal and external audit processes.
7. Key Performance Indicators (KPIs) and Metrics
   To effectively manage business decisions and optimize clinical outcomes, providers must be able to precisely measure results and compare them to internal goals and industry benchmarks. The XiFin BI financial reports enable proactive management of your RCM process by providing visibility into KPIs, preparedness for audits, and insight that can be used to streamline your operations. Our enterprise-grade data warehouse and reporting application is designed specifically for the healthcare environment, offering detailed insights and retrospective analysis of prior periods.
   
8. Supporting Compliance and Auditability
   Healthcare providers must have an RCM system with a financial foundation that delivers a complete financial accounting package compliant with GAAP, FASB, and Sarbanes-Oxley (SOX) requirements. This level of compliance and integrity is necessary for maintaining investor confidence and meeting regulatory standards. XiFin solutions are designed to comply with FASB 606 and PAMA accounting requirements, among others. The platform provides reports that address the unique financial nuances of healthcare reimbursement, ensuring complete visibility into financial performance and tracking KPIs with precision. All data can be traced back to its source, meeting audit requirements and providing a robust audit trail.