Revenue cycle management is becoming more elusive due to the evolving healthcare industry. Many hospitals are now struggling to retain income under a value-based care payment model due to new legislation and reforms that have pushed the industry to shift.
In 2019, community hospitals in the US alone supplied $41.6 billion in unpaid treatment. This sum may seem high, but many additional reasons go into the enormous debt that healthcare organizations are under, which hurts their capacity to make a profit. We will now provide an example of how to handle issues with income in the healthcare sector.
Today’s technological platforms could improve interactions and communications between providers, payers, and customers, leading to a more robust revenue cycle management strategy. Revenue cycle managers should focus on a few critical areas for a medical institution to maximize reimbursement.
The problems RCM runs into most commonly include:
- Typographical mistakes occur when patients register, leading to non-clinical insurance payer rejections.
- Inadequate medical coding practices that lead to payment rejections.
- A lack of digitization hampers improper payment management and patient-provider communication.
- Delays in resolving insurance payment rejections cause a delay between seeing the patient and obtaining reimbursement for the treatment.
These problems are still present in most healthcare institutions operating in various specialties. However, by using specific efficient troubleshooting procedures, these problems may be fixed. Here are five tried-and-true techniques for enhancing RCM to increase output.
Optimal Techniques to Enhance RCM
The five key strategies that you may use to improve clinical processes and healthcare revenue cycles are examined in this article.
Utilize Software and Tools to the Fullest to Improve Your RCM
Using software and tools to manage your revenue cycle management software as well as online client portals, the best course of action moving ahead is to simplify client interactions and payments. Data collection is crucial when it comes to upgrading technology and services. Looking at trends in customer metrics, like visitation rates, episode occurrences, payment rates, etc., may help your agency make data-based choices. Additionally, centralizing all data related to accounts receivable facilitates better client billing and payment processes.
By allowing users to examine health information, pay outstanding balances, request prescription refills, and message physicians, online portals provide people greater control over their health and well-being. Patients may also check-in for appointments or reschedule them. A lack of digital solutions slows down the revenue cycle, makes it challenging to engage with customers and suppliers, and detracts from your company’s reputation.
Prioritize a Patient-Centered Strategy
A patient-centered approach is another way to improve the revenue cycle in the healthcare industry.
According to a study, 49% of patients said that their decision about healthcare providers is influenced by having access to reliable information on charges and services. If a hospital implements modern data processing, medical billing, and payment mechanisms that make knowledge evident to patients, people are more inclined to use the hospital’s services. Therefore, it has been shown that enhancing frictionless and instructional patient experiences can boost healthcare income.
Make sure all operations, from gathering insurance information to accepting payments, are straightforward and beneficial for patients.
In this case, implementing the right software is crucial. For instance, patient engagement software offers automated administration tools, patient education, patient support modules, and better communication channels that simplify hospital-patient interactions and reduce paperwork. Patient-provider contact is facilitated through electronic health records (EHR), telemedicine, electronic prescriptions, and online scheduling applications.
Education and Training for Medical and Administrative Staff
The management of the hospital revenue cycle is complicated by the medical and administrative staff’s lack of knowledge and training. If even one employee fails to fill out a patient’s information or charge them correctly, the process collapses, and the odds of being paid quickly decrease.
Healthcare organizations must thus educate their workforce about financial principles and try to integrate all staff members across departments. According to the study, a lack of training commonly contributes to discrepancies in patient financial data across departments. The likelihood of inconsistent patient experiences and back-and-forth transmission of patient data will thus be reduced due to training.
Hospitals may train staff, for instance, by employing scripting, coaching, observation, and real-world situations to provide them with the information, skills, and experience they need to handle financial challenges when interacting with patients.
When adopting new software, you must inform your personnel about the need for the changes and how they will improve routine hospital operations. To save time learning how new features work, you should also teach staff members how to use the systems.
In-depth training for medical and office workers increases employee loyalty, reduces attrition, and enhances patient care. Increasing staff retention is another way to optimize healthcare revenue cycle management.
Create objectives and track KPIs
We constantly ask billers, collectors, cash posters, and other back-office employees about their productivity objectives during revenue cycle reviews.
The fact is that workers who have objectives are more motivated to achieve them. Knowing the anticipated money they will create is also advantageous to them. If expectations are unclear, billers may generate work at wildly different rates. One person could submit 200 claims daily, while the other only submitted 30.
Another essential advantage is keeping updated financials. You cannot conclude your month if your cash posters are posted a week late. You cannot communicate financial information to those who need it to make business decisions. To keep your cash posters up to date, you can determine if you have the proper personnel by setting objectives and tracking your progress. You can also choose whether specific processes need to be changed or streamlined.
Simplify Point of Service (POS) Payment
Some of the front-end changes you may make to cut down on rejections and back-end rewrites were previously discussed. By planning eligibility checks, selecting the proper payer, and giving correct insurance information, rework may be reduced. Error reduction may be aided by simplifying and streamlining processes and training staff members on the new methods.
Additionally, we suggest that you plan your POS data collection. Collect copayments before the service is given or demand payment from the patient before departure. This will significantly impact your ability to enhance your revenue cycle.