For those in management, improving the healthcare revenue cycle increases the likelihood that your organization will thrive and remain financially sound. Medical billing and coding are foundational to the financial success of a medical practice, and your actions to address revenue cycle management are the path to a better future.
- Room for Improvement
Recognizing the struggles of your current management processes is the first step in moving to greater potential. It is easy to recognize the need to improve efficiencies and to cut costs, but these aren’t the only threats your revenue faces. Claims reimbursement rates continue to decline, healthcare policies continue to change, and value-based purchasing is emerging as the new trend. There are multiple factors impacting inefficiencies in revenue management, as patients tend to receive care regardless of payment potential, complexities are always emerging with the rules for claims reimbursement, and insurance companies are less than excited about paying out due funds.
Awareness of new trends like healthcare consumerism and value-based reimbursement are crucial to understanding the expectations for care delivery and subsequent payments. The consumer and market demands are requiring more from healthcare organizations. While the complications can interrupt or frustrate revenue cycle management, there are options for improving medical billing and collections processes.
- Create a Seamless Journey Through the Revenue Cycle
In traditional office processes, there is a division between front- and back-end revenue cycle tasks. The front-end handles the collection of patient information, addresses eligibility and coverage, and enters new patient data. The back-end staff typically address the claims management process, from initial billing to denial investigation and follow-up collection efforts for the patient’s financial responsibility. These distinctions between tasks can upset efficiency on the path to finalizing healthcare payments.
Optimizing the revenue cycle should begin with breaking down the traditional norms of who handles the management tasks. Your office may not have the experience or time to effectively make this transition, leading to your need for third-party assistance. Medical billing companies like PracticeForces have all of the resources needed to create a more streamlined, efficient, and more accurate reimbursement process. However, your entire team should have a solid understanding of the entire collections process and how each person’s actions impact the ability to bring in revenue.
- Rely on Data to Inform Practices and Track Performance
You can’t make changes and create room for improvement if you aren’t sure of what is going wrong or where the weak links in the system are. Thanks to the development of software, artificial intelligence, and data processing, data is more available than ever to inform decision-making. Healthcare leaders now have resources available that will define the metrics, trends, or financial positions of the company in just a few moments. Revenue cycle leaders can rely on this data to influence the financial health of the company.
Manual efforts are still required to input the information needed to generate data reports, but a data-driven revenue cycle exposes the limitations of relying on human calculations alone. Key performance indicators (KPIs) can be evaluated concurrently, such as claim denial rates, net days in accounts receivable, cost to collect, and more. This information can be used to motivate and educate non-clinical staff and service providers on ways to deliver more efficiency with less expense. Data supports reasoning to make changes and encourages compliance from team members.
- Move Toward Time-of-Service Collections
Many individuals have opted for enrollment in high-deductible health plans in an effort to reduce the burden of expensive premiums. These changes have given patients the brunt of the bill for any healthcare services they receive, often a responsibility that patients aren’t always able to meet. It is estimated that two out of every three patients do not pay their medical bill in full. This creates an incredible financial loss for care providers and organizations. Late payments and non-payments cripple the healthcare revenue cycle.
In addition to never receiving the funds owed, there is a significant amount of time and energy spent on collecting these debts. Lack of income is compounded by additional expenses. Revenue cycle managers can put a halt on these open and floundering accounts by instituting pre-service payment requirements or point-of-service collections. In order to do so effectively, patients need to be given an accurate financial estimate of what their care will cost. Software tools can improve more immediate access to these estimates, just as the implementation of credit-card-on-file tools to generate automatic payments will improve revenue collection.
These three areas may not seem difficult to implement, but any efforts at change may be stunted by a lack of training, experience, or understanding of the big picture. To avoid a delay in moving forward with new revenue cycle opportunities, consider working with PracticeForces for your medical billing and coding needs.