Patient care may be the priority, but it’s only half the equation for healthcare facilities that also need to maintain financial organization and stability to support that care. So, why do so many hospitals still accept a sluggish revenue cycle as the status quo?
The most effective solution for better revenue cycle management (RCM) is probably already in the center of your tech stack. Electronic health records (EHRs) not only document care but can also act as a financial engine to bridge the gap between patient care and prompt reimbursement. Discover how to bring the two sides together to alleviate tedious administrative burdens.
Challenges hospitals face in revenue cycle management
The Hidden Administrative Tasks Draining Small Practices
Small practices play a critical role in healthcare delivery, but they cannot continue to absorb ever-increasing administrative demands without consequences.
RCM is an end-to-end workflow that starts before a patient even arrives and doesn’t end until final balances are resolved. RCM accounts for the entire care journey, from scheduling to clinical encounters and all the way to patient checkout.
The problem is that these processes are highly complex and often disorganized. This is especially true of behind-the-scenes administration and documentation, whether it’s checking insurance, reviewing claims for necessary health information, processing claims, or billing patients. Healthcare facilities are holding onto legacy processes at the expense of efficiency.
Outdated RCM processes to leave behind
RCM has become a burden because hospitals are still trying to handle it the same way they did 30 years ago. Modern EHR technology eliminates disorganization and manual processes.
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- Reliance on paper: Continuing to use paper-based processes alongside an EHR disrupts staff workflows as they stop to track down physical files, resulting in lost time and productivity.
- Fragmented information: Coordinating with multiple departments across disconnected systems — often from third parties — makes it difficult to match patient information and share billing data.
- Manual charge capture: Relying on manual data entry over automation slows the billing cycle and collections.
3 ways to use EHRs to improve revenue cycle management
EHRs bring data together under one roof to drive effective RCM. Minimize your paper trail and automate key activities by using one software system to collect information and speed up RCM activities.
Automate workflows – Provide staff with the tools to support RCM. To start, integrate worklists into your EHR to control the flow of tasks to the right clinicians (e.g., assigning users to specific payers, such as Medicare or Blue Cross). Hospitals can also streamline collections by enabling one-click features — such as clickable phone numbers — to keep data on one screen and billing templates to automate charge capture based on selected service(s).
Manage compliance – Effective RCM goes beyond billing. Empower the organization to adhere to health regulations and organizational processes by making it a whole-team effort across compliance, clinical, finance, and IT teams and putting guardrails in place. Several EHR capabilities can support compliance across the board, including:
- Creating custom bill holds to match specific billing rules and regulations
- Automating code updates, including pulling in new ICD-10 and CPT codes
Create a robust audit system – Build an automated auditing process to improve efficiency over time-consuming, manual efforts. EHR-driven auditing allows hospitals to randomly select claims and email the audit list to staff, while monthly reporting identifies workflow problems quickly to prevent those errors from affecting hundreds of claims.
Empower teams to use the EHR for revenue cycle management
Too many hospitals fail to use their EHR to its full potential because staff members don’t understand how to use it to automate tasks. Overcome this by committing to ongoing training across the workforce, so team members understand the software and its RCM features and workflows.
Communicate changes
Actively communicate key changes — from workflow processes to software updates — surrounding your EHR and revenue cycle management. For staff members to realize the full benefits of a change, such as reducing a three-click process to one click, leaders must share how and why it’s important.
Create more effective RCM processes
Your hospital’s financial health depends heavily on the technology that powers the rest of your operations. Support the care journey from check-in to billing. Reevaluate the software already at your fingertips and find the untapped potential of your EHR for a more resilient revenue cycle.
Photo: Witthaya Prasongsin, Getty Images
Carolina Salazar Torres is an applications analyst at Juno Health with more than two decades of hands-on experience in healthcare revenue cycle management. With a background that's grown from certified medical coder to manager and compliance specialist across multiple healthcare settings, she understands the challenges that come with upgrading RCM workflows.
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