Health IT, MedCity Influencers

How to improve revenue cycle management: 5 tips

Especially in a tough economic climate, healthcare facilities need more efficient ways to improve cash flow and remain stable by ensuring claims are accurately processed and quickly paid. 

As the world continues to battle Covid-19, its effects on population health are just one facet of the crisis. The economic fallout is also seriously impacting both people and businesses, including hospitals and other healthcare facilities.

The American Hospital Association (AHA) estimates the country’s hospitals and health systems could lose $120.5 billion between July and December 2020. This is in addition to AHA’s previous financial impact estimate — losses of $202.6 billion between March and June 2020 — bringing total losses for the calendar year to at least $323 billion. Half of all hospitals could be operating in the red during the second half of 2020, according to analysis prepared by Kaufman Hall and released by the AHA.

The financial hit stems, in part, from factors such as loss of insurance following job loss. Without insurance, many people put off non-emergency healthcare and elective procedures. Even those with insurance may postpone or cancel elective procedures to avoid being indoors, where the virus can spread more easily. Inpatient procedures and surgeries continue to trail 2019 levels — they’re down 18.6%, cumulatively.

EVen with vaccines in the near horizon and new outbreak hotspots emerging all the time, it’s clear the virus will be with us for some time, and its economic effects may linger for years. This makes it critical that health facilities and their finance departments find ways to make revenue cycle management (RCM) more efficient to improve cash flow and remain stable. These five tips can help.

Invest in your staff
Your front office staff is a crucial asset in the RCM process. Recruit good people and train them to capture the right information and give patients a clear view of their financial obligations and payment options (if needed). With more upfront visibility, patient engagement will increase, and so will the likelihood of bills and claims payments.

Get your coding up to speed
The latest medical coding compliance technology can identify and correct processes that can lead to denied claims before claims go to payers. Robust coding processes and contract compliance automation systems help hospitals get ahead of coding and medical necessity denials. These systems also help coders, financial analysts and providers submit clean claims the first time, reducing the claims denials.

Review denied claims quickly
There is a difference between rejections and denials. While rejections are generally a lost cause unless the account is reworked or appealed, denials offer a glimmer of hope. The payer may just need authorization, updated coding, or additional information. Addressing any denied claims within 24 hours of receipt increases the potential that the claim ends up being paid.

Find modern solutions that work for you
A variety of technology-based options can benefit an RCM process. Payment variance reporting solutions can identify underpayment and overpayment trends for analysis with broad-reaching, sustainable return. Chargemaster assessment and management tools and concurrent charge integrity tools are not widely used, but they are highly effective in helping to boost revenues. Robotic process automation allows a facility to use a “bot” (i.e., a software application programmed for a specific function) to perform repetitive tasks — such as prior authorizations, code review or checking claim status — faster than a human can, and without variation or error. If you’re not sure where to start with all of the options out there, find a consultant who can guide you to the right technologies for your business and help you deploy them.

Consider outsourcing
Outsourcing RCM can help hospitals gain control of revenues and streamline business processes while bringing them closer to their patients. Companies that specialize in RCM often have tech expertise and can use their capabilities in data analytics, automation and artificial intelligence to improve and automate a hospital’s RCM processes.

Additionally, finding a partner with customers in a variety of industries can bring fresh perspectives to a health system’s business, but experience working with organizations serving similar populations — such as the number of covered lives or hospital beds — is also important.

Better Processes, Satisfied Patients
Especially in a tough economic climate, improving RCM processes is essential to boost the bottom line and reduce claims denials. These five tips can guide health systems toward a more effective method of collecting revenue — and with fewer denied claims and faster, more accurate claims processing, your patients will be happier, too.

Photo: sorbetto, Getty Images

 


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Donna Martin

Donna Martin is the Senior Vice President of Global Healthcare Business Development with HGS, a provider of business process management (BPM) services. In her role, she is responsible for overseeing new business development in the payer, provider, lab/DME and pharmaceutical sectors. She has more than 20 years of experience in the healthcare BPM industry, with a diverse background in operations management, global health administration, population health management and workforce management. Donna holds a Bachelor of Science degree in business administration and marketing from the University of North Carolina.

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