Revenue cycle management is a comprehensive process with multiple factors. Accuracy and efficiency are essential to streamline claim filing and receive adequate reimbursement. These factors are crucial for protecting healthcare practices from revenue leakages.
Whether it is recording and documentation or claim filing or submissions, careful handling is necessary for healthcare practices. Being in contact with insurance providers is equally vital for healthcare providers. Together, all this is necessary to prevent claim denials and delays.
Doing all this takes time and resources along with some knowledge and expertise. However, healthcare providers may be struggling to keep up with all this while taking care of patients.
Amidst this, all they need is a way to manage everything with precision. They need to optimize their revenue cycle management to improve their overall profitability and make medical billing seamless.
This is important to lead the way in altering medical trends and essential guidelines.
In this blog, we will explore various trends that require attention and understand how healthcare providers can counter these trends with effective revenue cycle strategies.
Trends Affecting Revenue Cycle Management
After the pandemic, the healthcare industry has suffered a lot of instability. This has created a prolonged impact that healthcare practices are still sustaining in 2024.
Following are the trends that need formulation of new strategies for revenue cycle management:
Rising Inflation in the Healthcare Industry
Inflation has been a rising trend in medical care and the healthcare industry is heavily influenced by it. This has left patients wondering if they can afford medical facilities or not.
This concern for patients directly affects the dynamic of revenue cycle management. As more people opt out of medical facilities, healthcare providers struggle to achieve adequate revenue.
Only an efficiently functioning healthcare industry provides healthcare providers and practices a place to thrive financially. The rising prices of healthcare can directly impact other aspects as well such as labor cost, supply cost and the service cost.
Dependency on Manual Medical Billing
In 2024, the time to leave behind manual medical billing has come. The healthcare practices that are still trying to optimize their revenue cycle with manual processes are lagging.
There are enough drawbacks to carrying out medical billing manually. The most common issue with manual medical billing is the frequency of errors. Any type of error while recording, documenting, and coding can result in denials and revenue leakage.
Also, technologically advanced tools are more efficient, and they can complete piling tasks effortlessly in less time. Employing staff to handle complex medical billing not only needs more investment but also increases the number of inaccuracies.
Increasing Rates in Claim Denials
According to CMS reports, on average 17% of claims get denied due to various reasons.
This increasing rate of denials is not profitable for healthcare practices. The best course of action is to take measures to eliminate unwanted denials.
There are numerous reasons behind claim denials and preventing them is essential to keep the healthcare practice profitable.
Some of the common reasons are errors in documentation such as inaccurate patient details and mistakes in coding or missing details. Other than that, delays in submitting claims can also be the reasons behind denials.
There is a scope to recover denials, but this takes time and resources. That is why addressing the issue from its origin is vital to improving revenue cycle management.
Medical Billing Regulations & Compliance
Meeting compliance standards plays a crucial role in attaining patient trust and loyalty.
This is a common concern for patients if their sensitive data is safe or not. This is because sensitive information is prone to misuse and data breaches. When healthcare practices are transparent with patients about pricing, patients are more likely to trust the services.
Whether it is coding compliance, HIPAA compliance, or transparency, all these factors affect the revenue cycle management. When healthcare providers think about improving their bottom line, regulatory compliance and transparency become significant.
Challenges in Staff Management
Operational management is no joke with the number of patients showing up to the healthcare practice. A failure to handle the staff efficiently is also a prime reason behind a low-performing revenue cycle.
When it comes to the staff, the most important thing is providing infrastructure for them.
There are other factors such as staff shortage, manual errors, lack of medical billing skills, and staff leaves. All this can hamper the flow of medical billing of process and disintegrate operational management.
The healthcare practices and providers opting for an in-house medical billing staff have to take care of many aspects. All this only adds to the burden of administrative tasks and does not solve it. This trend can be detrimental to the financial health of healthcare practices.
Revenue Cycle Management Strategies for Improvement
Dealing with these trends can be cumbersome but it is essential to upgrade the bottom line. With a few strategies, healthcare providers can improve their operational management and boost revenue cycle management.
One thing that healthcare providers must understand is that medical billing is a comprehensive process. Healthcare practices need to take care of every step in medical billing for satisfactory results. Whether it is the collection of patient information, recording and documenting, or coding and claim filing, every part is important. Efficiency is crucial on the front and back end.
Complying with Regulations & Maintaining Price Transparency
The first strategy is complying with all regulations and policies. This means making sure healthcare practice follows all requirements of HIPAA to prevent sensitive patient information from being misused.
The second is staying honest and transparent about the financial responsibility of the patient. Determining patient responsibility increases patient loyalty and reduces denial rates. This directly benefits effective revenue cycle management and helps healthcare providers in uplifting the bottom line.
Simplifying Eligibility Verification & Prior-Authorization
Insurance eligibility verification and prior authorization are the initial steps in medical billing. Setting the standard of accuracy and efficiency in the beginning can make a lot of difference in the end.
Healthcare providers must ensure to eliminate errors at the time of verification and authorization. This reduces the overall number of denials and helps healthcare providers in achieving adequate revenue.
Focusing on Timely Detection of Underpayment
The healthcare practice may be facing underpayment but if it doesn’t come under notice they can make no change. Timely detection is the ultimate solution to follow up with effective strategies.
Healthcare providers can take essential measures only when they know how to deal with underpayment. Underpayment is not something that a healthcare practice would want as it affects the financial dynamics.
The need here is for skillful coding to reduce the number of errors and increase the clean claim rate. Even after this, if the underpayment still exists, healthcare providers must analyze the reasons and follow up to take corrective measures.
Establishing an Organized Denial Management
Did you know?
Almost 20% of insurance claims are denied, rejected, or underpaid!
The occurrence of denials may be common but not lack of proper denial management. Effective denial management can help in the recovery of lost revenue and rebuild the financial stability of the healthcare practice.
Denial management is something to follow after denials but also a practice to identify the reasons behind denials and taking proactive steps. Actively analyzing the areas of errors and altering practices can reduce the number of denials in the first place.
Outsource Medical Billing to Optimize Revenue Cycle Management
Ongoing trends may not be the best thing for your healthcare practice. If your goal is optimizing revenue cycle management then professional assistance can help you.
This way you get the expertise to solve your medical billing complexities and compete with trends. On the other hand, you can focus on rendering quality services to patients.
This way healthcare providers can relax by shifting their burden to experts. As a result, healthcare practices can maximize their revenue and improve operational management without much hassle.
Bottom Line
As time moves, trends change and evolve in any industry. However, in the case of medical billing healthcare providers must follow what suits them. If the goal is upgrading revenue cycle management, then effective strategies are a must.
As a healthcare provider, if you feel that you lack administrative tasks, outsourcing is the option for you.
Eminence RCM is a well-established medical billing company that has been working with healthcare providers across the USA. We understand the importance of maximizing revenue and improving the workflow.
Our team takes care of every single detail and helps you throughout the medical billing process. We have worked for various specialties, and this makes us experienced at handling even the most difficult billing situations.
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