RCM VULNERABILITIES: TIPS FOR EFFICIENCY

While it might look easy, looking from an outsider’s perspective, and on the surface level, but one of the most back-breaking aspects of a healthcare organization is its revenue cycle management.

You would say, how difficult can it be?

A doctor providing treatment and patient paying the fees?

But the revenue cycle is more intricate and includes more than just patient paying the bills at the payment counter.

Despite being the driver of a hospital’s financial health, not every hospital invests judiciously in a revenue cycle management system. As per a recent survey published by the Black Book, a study conducted on 522 hospital and healthcare delivery networks revealed that a 26% of hospitals do not have an effective revenue cycle management system in place.

Not having a robust revenue cycle management solution can lead to your hospital losing on a significant amount of revenue generation opportunities. Not just that, a revenue cycle management solutions provide the healthcare organizations with the benefit of reducing their claim denials, boost their productivity and streamline the financial process adhering to the compliance policies, without any hassle to the practicing staff.

If you haven’t by now, we would suggest you make a profitable investment and hire a medical billing and coding company,  like Medphine that will provide comprehensive revenue cycle management services. We offer complete revenue cycle management solutions with our dedicated practice managers that will ensure a saving of 70% in the operating cost. Tailored per your practice’s needs, our solutions will ensure maximum return on investment, prompt reimbursement and smooth processing of operation in practice.

Years up until now had a significant impact on how a healthcare organization’s RCM has evolved. The shift to value-based care, enforcement of bringing more transparency to the patients via the healthcare transparency bill has left healthcare organizations, payers, providers confused with challenges in managing their RCM.

Challenges that healthcare organizations might face in the coming year are:

BILLING AND COLLECTION MISTAKES:

Billing and collection are umbrella terms given to how revenue cycle is maintained in a healthcare organization. Slight mistakes in writing the wrong name or diagnosis codes can lead to denial of the submitted claim. Massive rework, significant loss of revenue. Some of the substantial billing and collection mistakes are inaccuracy, the inadequacy of information, lack of control improper denial management and not having a robust revenue cycle management strategy.

• CODING ISSUES:

With WHO updating the standards for coding and diagnosis, ICD 10 being adhered to as for now, the growing compliance requirement has become a hassle for the healthcare organizations. Staying compliant with ICD 10 requires diagnosis documentation which most healthcare providers end up making errors to. Incorrect code mapping, insufficient diagnosis codes, increasing work pressure are some of the significant coding challenges that have the potential to damage the healthcare RCM.

• DENIAL MANAGEMENT:

Per the recent data released by the partnered study of BESLER and HIMSS, denial management and reimbursement are some of the biggest vulnerabilities of a revenue cycle in a healthcare organization. Claims get denied due to several mistakes, reasons as minor as putting inadequate/ inaccurate information of the patient or a colossal blunder like mentioning invalid codes. These negligences can lead to organizations having to pay a significantly higher amount in submitting the claims.

• ACCESS TO PATIENT’S DATA:

One of the riskiest areas that have the potential to shake the revenue cycle of a healthcare organization is the patient’s data. While filing the claim or when registering a patient, any minor mistakes in accessing patient’s data can have an adverse impact on the revenue, resulting in a significant loss. Errors such as inaccurate collection from another patient, or unable to collect copayments can lead to massive satisfaction among the patient as they also have to go through the hassle of cross-checking information with the insurance company bothering them to pay the amount for the treatment and care they have received.

• CHARGE CAPTURE:

An efficient billing cycle is the one that regularly and accurately updates the prices for the services being dispensed, per the updated Medicare guidelines. It is crucial to manage and maintain an unambiguous charge capture. But this is not possible without adequate knowledge and training and failing to do accurate charge capture can risk healthcare organization’s million in revenue loss.

• SHIFT TO VALUE BASED CARE:

While the transition from fee for service to value-based care is a massive and impressive step towards dispensing quality treatment at an affordable price, the implementation has its share of significant challenges which healthcare organizations are facing. The attempt to cut down on the cost without compromising with the performance and quality of treatment is difficult as the transition from the outdated process will involve getting rid of lengthy claim processes and reimbursements cycles, which can be a strenuous task. The obsolete technology is coming in the way of data sharing between the health plans and providers, which is imperative for the success of the value-based care model.

While there are challenges, there are solutions to them, as well, so that your healthcare practice revenue cycle functions properly in 2019 without any roadblocks:

• Regularly train your in-house staff to perform accurate billing, collection, and coding and keep them updated with the changing regulations and policies of the Medicare, CMS, and other healthcare authorities. You can do this or hire a certified and trained medical billing and coding company for competently managing your practice’s RCM.
• Why waste staff’s potential in a task like a claim denial follow up and management when you can automate these processes? Instead of using a manual management system, switch to automated processing which will increase the accuracy rate and save significant time, thereby enhancing the efficiency of the medical staff and organization.
• Transparency with your patients will go a long way. Make sure that all the patient’s queries are resolved to their satisfaction be it about a financial policy or the pricing of the procedures. Furthermore give your patients more control over the payment choices, as this will reduce the hassle of follow-ups, copays and ultimately benefit your practice’s account receivables management.

Invest more time in dispensing quality treatment and care to your patients and let the Medphine’s professional efficiently manage your revenue cycle.

Would you instead prefer a trial service first to see how we do what we do?

Try Medphine’s 30-day risk-free service without any obligation of signing a long term contract and watch as we escalate your healthcare practice profit.