As per a report by Global Market Insights, the projected market value of revenue cycle management in the healthcare industry will be more than $275 billion by the end of 2028. This figure clearly states the importance of managing the revenue cycle for all healthcare providers.
No matter what the size of your healthcare organization is, taking care of your revenue cycle means that you are improving your bottom line. This means that you are working to reduce the number of rejected claims and shortening the payment lag which will result in a smooth payment process.
All these things collectively work towards increasing the overall efficiency of the organization and bringing more money into your healthcare practice.
Despite various medical claims that healthcare providers send out to insurers, it is very important that the entire revenue cycle management is kept simple and effective from the beginning to the very end.
To deeply understand how the revenue cycle can be improved, the practice should continuously work on improving the workflow. This will save you from leaving money on the table that can hinder patient experience and contribute to disturbance in the workflow.
Before getting into the ways to improve the overall efficiency of your revenue cycle, it is important to understand the problems that complicate your revenue cycle.
One of the most common factors that lead to revenue loss is the poor monitoring of AR and claims. Whenever the claim is denied, and the provider fails to identify the situation because of poor management, it can lead to significant financial damage to the entire healthcare.
When the staff in the healthcare is not familiar with the process, the entire revenue cycle management keeps getting complicated. The process is chaotic, and it is not possible for under-trained staff to handle it. Different errors like - improper coding, incorrect billing, missing items in data collection, wrong dates, can lead to disastrous results.
Being a Healthcare Provider, there are times when the schedule of the entire medical team can be pretty hectic. This results in them becoming more process-centered than ideally needed. It is not an easy task to manage the quality of patient care along with taking care of reimbursements.
It is crucial for every healthcare provider to fully comply with the standards set by HIPAA. The guidelines keep on updating and it is important to stay compliant with the updated guidelines. One of the most prominent challenges for healthcare providers is to save themselves from HIPAA violations.
Keeping the Challenges in Mind, Let’s Discuss the Ways to Improve the Overall Efficiency of Your Healthcare Practice
When we talk about maximizing the efficiency of healthcare, the first step is to get the right number of patients. There are two ways to do this-
Both these ways play a big role in improving the revenue of your healthcare practice.
One of the most overlooked ways to improve revenue cycle management is to be more serious about patient insurance verification. As soon as a new patient enters for the treatment, make sure you verify the insurance before treatment is provided. If it is necessary to do pre-authorizations, you must have a good follow-through plan in place to make sure they are handled in a timely way.
Around 99% of Medicare Advantage participants have plans in which prior authorizations are a necessity. If these requirements are not checked by a provider in advance, it can lead to delays in payments from the patient’s end.
Various organizations like - Medicare, Medicaid, and other commercial payers all have their own rules regarding what codes to use and how to submit claims. One thing to know about these rules is that they can change at any moment. For the big organizations that work with multiple payers, keeping up with the payer guidelines can feel like a second job. To ensure that every claim is sent to the right payer and all the latest requirements are adhered to, there must be a reliable medical billing partner like – Eminence RCM to handle these rules and guidelines for your healthcare.
It is not enough that your claims are submitted to the payer in a correct manner. A successful and profitable practice is only possible with efficient medical billing and collection processes. However, with the passage of time and changing guidelines, it becomes more challenging to collect payments from patients and insurance companies. Your financial responsibility continues till you are able to capture the entire patient payment. One of the right ways to improve the payment collection process is by giving patients options on how to pay. To increase the chances of capturing payment, you can additionally consider offering payment plans.
The medical claim billing process of your organization has the power to make or break the entire revenue cycle of your healthcare organization. On the healthcare provider’s front, claim processing involves reviewing the billed amount for coding and submitting it to the insurance carrier after eliminating errors. A rise in claims denial rates, no proper reimbursements, and improper accounts can point to problems with your billing processes. While initiating appointments, patients may have changes in insurance coverage, addresses, or other information that can affect claims and billing. Claim processing becomes more problematic and challenging because it involves addressing at least a dozen steps before the bill is actually submitted to the payer.
Denial of claims is an inevitable thing. However, paying attention to the details and carefully planning the entire billing process can help minimize the entire process of claim denials. No matter how you choose to manage your revenue cycle, one thing that every healthcare provider aims for is to maximize the first-pass acceptance rate.
Uncertainties continue to put enormous pressure on healthcare organizations’ bottom lines and the situation is exacerbated by the unresolved claims denials. They represent an average annual loss of $5 million for hospitals representing up to 5 percent of net patient revenue.
The good news is that the denials are not automatically put in the write-off bin. In fact, out of all the denials, as many as two-thirds of rejected claims are recoverable if they are followed aggressively.
To ensure an effective denial management process, there must be continuous monitoring to ensure success in the process.
From collecting patient payments to ensuring revenue is properly managed, having the right team is critical for the healthcare provider. It is true that technology is entering every field. But it still can’t fully replace the value of staff members in healthcare organizations. Even if you have all the proper tools in place, if the staff is not trained enough to use those tools effectively, revenue cycle management is bound to suffer.
When we talk about investing in staff of healthcare organizations, it means:
Every person, whether he is in the front office or back office plays a key role in improving RCM processes. So, they need to have a keen understanding of all the steps and processes. Proper Staff engagement within an organization means making each person’s value clear and then giving them the tools, they need to succeed and complete the medical billing process.
During the entire process of medical billing, it is important to remember that the patients are a foremost priority. While carrying out the steps in the entire revenue cycle process, there are certain points that can positively or negatively impact the patient’s experience.
While the patient is accessing your facility, printed forms take too much time to complete. This can create a bad impression at the very first. To overcome this problem, give patients the option to provide their information through an online patient portal when they visit. It gives patients the flexibility to provide necessary information for treatment in their own time and it also saves a lot of time during the entire appointment.
Once you start targeting the growing challenges of your healthcare practice and navigate the delicate balance of providing patient care and maintaining profitability, you are heading in the right direction. If you want to prioritize an efficient revenue cycle, it is important to identify what part of the cycle you want to focus on and turn the entire workflow accordingly. No matter what strategy you are implementing, the basics will remain the same. Verifying eligibility and patient demographics and creating a claim by applying appropriate codes plays a key role in the entire revenue cycle.