In today’s consumer-driven healthcare industry, Revenue Cycle continues to have to evolve and change to fit the market demand. With declining reimbursements, high deductible plans, and increasing complexity around multi-payor interactions for payment, the ability for RCM to continuously improve becomes ever-more difficult by the day. The ability to cut costs and increase productivity is easier said than done and new & innovative ways to do so need to be introduced. Some key ideas are listed below.
Mister Healthcare Provider, Tear Down this Wall!
The truth is that the various roles within Revenue Cycle are very segmented and siloed. Many employees are only familiar with their own role in the organization and are unaware of the over-arching process of patient onboarding and care services. When front-end and back-end services are integrated such that they can visualize end-to-end, can allow staff to anticipate any possible payment challenges much earlier in the process. A 25-bed hospital in Illinois reported a 300% increase in point-of-service collections by blending the lines between these roles. That is a substantial increase for which a blend of people, process, and technology can make a massive difference in an organization.
Mine Your Data and Take Action on It!
Not enough companies are really leveraging their patient and operational data to make insightful decisions around how to track and benchmark their efforts. Many EMR/EHR systems record a plethora of data, and by using Business Analytics tools like Microsoft Power BI and Tableu, your organization can review trends and patterns in the data that are not easily visible in manually compiled Excel reports. By understanding your Key Performance Indicators (KPIs) and being able to report on them quickly and consistently, you can produce actionable intelligence that was previously unavailable.
Know the Patient Responsibility Up Front
By leveraging concepts like “credit-card-on-file” and providing patients with up-front estimates for their service, providers can have a substantially better chance of collecting on the patient’s responsibility. A recent survey stated that about 68% of patients fail to completely pay their medical bills. By integrating with systems like Experian and/or the patient’s carrier directly, healthcare providers can gather up-front information about the patient’s exposure and even provide an “Estimated Explanation of Benefits” so that the patient is not blindsided by a bill they were not expecting and therefore are refusing to pay.
Automated and Instantaneous Authorizations and Eligibility
Continuing on the prior topic, the more systems, carriers, and providers that your organization can integrate with, the quicker you will receive tactile feedback for which you can make financial and operational decisions. By being able to approve prior authorizations and being able to confirm eligibility while the patient is on-site, providers can limit their exposure and recourse to patient financials and reimbursement. Additionally, by converting from manual authorizations to electronic authorizations, providers have seen, on average, a 75% reduction in per-verification costs.
By leveraging technology and integrations in new and intuitive ways, Revenue Cycle Management can continue to improve in many ways that were not previously considered. This is why healthcare providers need a consultant who can help them navigate through these various decisions and implementations to increase profitability and productivity within their organizations.