Applying stronger checks on transaction management and constricting loopholes within healthcare practice can improve revenue for medical practitioners.
In the modern day and age, the healthcare sector of the United States is facing a number of dilemmas, owing to a number of loopholes in the healthcare processing and transaction system. Cash flow is become increasingly difficult to ensure and secure, bad debt is on the rise, low-income patients are being sued by their hospitals, low-income America is encountering a multitude of barriers that are hiding successful healthcare plans and the overall profit revenue is on the decline. As a result, the priorities of healthcare providers are steadily diverting – from quality patient care to profit maximization and damage control, which is a deplorable tale for every stakeholder of the medical profession. Medical practitioners are facing a fight for survival, where they are struggling to maintain a balance between giving quality patient care and earning sufficiently for a living. However, despite all of this, there still are healthcare providers who are not only maintaining quality patient care and patient priority but are also able to maximize their revenue, by incorporating some sort of Revenue Cycle Management (RCM) plan into their practice.
In order to successfully incorporate an RCM into your system, first of all, you should understand the ins and out of your practice. Everyone has a different method of practice so you’ll have to self-conceive the entire process of your practice. You need to comprehend how the patient should enter your premises and how should his information be recorded by the front desk. Then, you should realize in which manner will you get reimbursed – would it be POS (Point of Sale) by the patient himself or will a third party (such as insurance company) perform the requisite transaction on the patient’s behalf? You’ll have to make an estimate for the expected number of customers per day and the estimated cash flow you’d expect yourself to make. Most importantly, you should try to figure out if there is any apparent loophole in your practice that can result in cash flow leaks and losses. Once you have visualized your entire practice, then you are ready to incorporate the requisite RCM into your system.
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Once an RCM has been integrated, you should try to perform a litmus test of its effectiveness to your practice and see if it fulfills your primary need of minimizing transactional losses and maintaining the continuity of cash inflows. There are several methods to do so.
One of the best and easiest methods to check the efficiency of your revenue cycle is by means of benchmarking. You can compare your data with your peers and competitors who have more or less the same practice method as yours are using similar forms of RCMs. This will quickly identify the areas and domains where your revenue management needs to be addressed. The best way to do this is by means of an Enterprise Data Warehouse (EDW). An EDW combines the financial, clinical and other information from your IT systems and use visualizations to optimize the data for in-depth analysis. This provides straightforward ways to discover the root causes of certain trends and other data patterns. A big-picture understanding of the information your healthcare organization is processing and cycling is imperative to success in the healthcare field. You can’t measure something that you aren’t bothering to manage, and using trends and benchmarking to manage such data will allow just that. A huge benefit benchmarking possess is that it uses information from similarly placed RCMs to identify the causes of financial problems in your practice, hence keeping your practice comparable to the best in your category.
A second method that can be used to check the efficiency of your revenue cycle is by means of data mining. Data mining is a process within the domain of EDW, the purpose of which is to analyze enormous amounts of data to process meaningful information based on trends and patterns. This can exactly pinpoint the fault in your revenue cycle. Data mining requires the services of a certified data miner who is optimistic and unbiased. Finding loopholes can be a painstaking task and a nuisance to rectify, but if one has to ensure that their practices are flawless in terms of revenue management, this stretch will have to be carried out. A good EDW, a solid analyst and a positive attitude to rectify faults form the best synergy to develop an extremely effective method of revenue management which can make your practice more successful and profitable.
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A third method that can be and rather should be used is internal assessment. You should ask your frontline staff to see if they have any problems managing your revenue cycle and see if they have any suggestions to solve it. Ask questions that pertain to the issue at hand, such as: What workarounds can we implement, and for how long should they be implemented? Have they felt any flaw in the current RMS system which is causing monetary loss to your practice? These people, while working on the frontlines, see things from the trenches – they address and solve day-to-day problems face-to-face as well as handle the technology that runs your business day in, day out. Therefore, their practical knowledge and experience can be utilized to improve your practice. You would be surprised by the answers and solutions you may find from these people. This method of revenue maximization and problem-solving separates those that take initiative from those that sit back and expect everything to be done for them. Make sure that your frontline staff plays an active role as it is an absolute necessity to ensure successful revenue management.
The fourth method in revenue management is to ensure that your patient is completely aware of the methods of payments that he is entitled to, against a certain ailment. He should also know the exact cost that he is liable to pay. Many customers get annoyed at hidden costs or they do not know how can they pay for themselves. By settling payment terms with the patient in advance, we can help them to understand exactly how much are they liable to pay and in what terms can they pay. Some customers are Medicate and can pay on the spot via POS. Some are Medicare and their payment needs to done by the insurance company. By pre-settlement of payment terms with the patient, you can ensure that you know the source of your revenue is, with regards to that patient. Also, making your patients clear about your RCM and speaking to their concerns individually, makes it pleasurable for them because it reduces their probability of getting annoyed at your system. Going the extra mile to make sure your patients receive the highest quality care has enormous benefits and rewards, the most significant of which being increased revenue and successful revenue management, resulting in successful healthcare practice. Great customer service with inquiries for improvement is a classic and hardened example of a successful business that has been in existence since the very idea of the free enterprise itself and it will certainly never fail you in the realm of healthcare.
A fifth method is to ensure that the data is correctly recorded. By data, we are referring to patient data, insurance company data and any other miscellaneous data which holds important to your practice. A glitch-free data source is important to track each and every patient and the relevant cash inflow against his profile.
A sixth method is to use automation in your practice. Human errors are inevitable; therefore, automation should take over repetitive tasks. Minimizing human role in simple and repetitive work can reduce the likelihood of developing loopholes and problems within your practice.
In a nutshell, the best method to ensure an error-free revenue cycle is to practice caution and cross checks. Interrogate your frontline staff if they have any problems with the RCM in practice, ask your patients if they are fully aware of the payment methods and the repercussions of non-payment (if any) and consult your EDW analyst if he identifies any loopholes in your practice. By keeping a regular check over your practice, you are covering most bases to ensure that your RCM practice is yielding the best output and there is minimal probability for any cash leaks and will give you a better chance to offer quality patient care to your customers, which itself becomes a competitive advantage for you and your practice.
