Healthcare revenue cycle issues can be found at every stage of the patient journey, from patient access to claims, invoicing, payment, and collections. Digital technologies and analytics, on the other hand, can assist providers in addressing their top healthcare revenue cycle concerns.
According to Director, Product Management, Contract Manager, Hospital, the complexity of our reimbursement structures and the complexity of billing mean that a variety of aspects impact revenue cycle management. Technology, regulations, changing contractual obligations and payer policies, people, processes, billing—each of these complexities adds to the challenge.
If revenue cycle management (RCM) concerns are not addressed, they can potentially lead to revenue loss. Data and analytics, digital tools, and automation can assist clinicians in managing complexity and adapting to changing patient needs. Here are seven of the major healthcare revenue cycle concerns and how providers are addressing them:
1. Patient accessibility issues
When it comes to choosing a provider, booking appointments, and managing pre-appointment procedures such as registration and insurance verification, consumers who are accustomed to utilizing mobile apps and online services for shopping and banking want frictionless digital experiences. Patients who do not currently use digital tools for healthcare said they would consider switching to a provider that provided a patient portal. The automated technologies that comprise your digital front door have a significant impact on patient engagement.
Digitally focused Patient Access Solutions, in conjunction with accurate estimates and convenient payment alternatives, assist clinicians in improving the patient journey and registration accuracy. Manual processes necessitate more staff work at the outset, and human error might result in claim denials or billing issues later in the cycle. Automation simplifies the procedure. Offering online or mobile access to patient intake software delivers the flexible and familiar digital experience that patients expect in today’s society.
2. Low collection recovery rate
Patients are finding it more difficult to pay as high deductible health plans require them to assume greater responsibility for their healthcare bills. Larger expenses can mean more confusion, more queries regarding insurance coverage, and a higher need for financing solutions. As the patient becomes more of a payer, providers will require effective collections tactics to improve revenue and reduce bad debt write-offs.
A patient-centered payment plan assists patients in better understanding their expected expenses, insurance coverage, and payment options. To properly guide patients through the financial process and overcome this healthcare revenue cycle difficulty, providers will need to offer them with:
- Clear, precise estimates that show patients how much they will owe up front
- Payment methods include cards, Apple Pay, and e-checks.
- Navigating payment plans to manage huge balances
- A procedure that encourages payment before or at the time of service in order to reduce future collections.
When providers must collect, digital technologies and analytics can help streamline the collections process by prioritizing clients that are most likely to pay, automating billing and messaging procedures, and even tracking the efficacy of outside collections agencies.
3. Incorrect billing
Claim denials stymie workflow by trapping employees in a cycle of claim submission, denial, rectification, and delay—thus disrupting revenue flow. A refused claim normally causes a 16-day delay in compensation. Worse, claim denials are on the rise: 69% of healthcare leaders polled by MGMA Stat reported an increase in denials at their firms.
By replacing manual operations with automated workflows, billing errors and A/R days can be reduced. Integrated claims management software checks claims for incorrect coding before they are filed, minimizing claims denials and shortening the time between billing and payment.
4. Underpayments in payer contracts
Missed and underpayments can cause stress and unpredictability to your revenue cycle. The source of these concerns is frequently payer contract issues.
Payers frequently know your book of business better than you do. When negotiating contracts, you must be able to rapidly and efficiently sort through vast amounts of material so that you may come to the table well-prepared. Contract analysis is one of the services we offer to help providers evaluate contract terms in real dollars and cents. Healthcare Contract Management assists providers with tracking erroneous payments and holding providers accountable for active contracts.
5. Modifications to healthcare regulatory and compliance requirements
New restrictions are a constant in the healthcare industry. However, this is one of the most significant healthcare revenue cycle concerns that providers must address. Failure to keep up with the constantly changing compliance landscape can result in claim denials, payment delays, and administrative and billing backlogs. Healthcare Regulatory Solutions, which include systems for generating transparent, patient-friendly estimates, can help you make regulatory compliance a regular part of your business activities. A free No Surprises Act (NSA) Payer Alerts Portal keeps providers up to date on the implementation of new NSA requirements.
6. A lack of data-driven measurements and insights
Increasing RCM efficiencies requires the use of analytics to provide a big-picture view of what’s going on throughout the company. This viewpoint is not necessarily the default in a busy healthcare office or hospital.
Comprehensive data and analytics are critical for providers that want to identify and address problem areas. Disparate systems and walled information might obstruct the creation of the single perspective required to diagnose the issues slowing down claims, billing, and payment. Revenue Cycle Management Analytics combines client data with non-native standard Electronic Data Interchange sets to identify process optimization opportunities. Providers may improve patient access productivity, billing efficiencies, reimbursements, and payer performance by leveraging the correct data.
7. Possibilities for security issues
Patient portals engage patients and give them the ability to arrange appointments, check test results, and make payments. However, as providers digitize to improve the patient experience and increase income, patient identities and data may be jeopardized.
As a safety for both physicians and patients, securely authenticating patients is crucial. Identity theft degrades the patient experience and undermines confidence, while dealing with the resource and reputational harm that fraud can create is a significant potential liability for providers. Working with companies who offer comprehensive Patient Portal Security and digital solutions that safeguard patient identities without generating friction or aggravation is critical to keeping patient data safe while not alienating patients.
Revenue cycle management healthcare difficulties are among the major tests that providers are currently facing. However, advancements in digital tools and analytics are assisting providers in maintaining revenue while focusing on both compliance and the patient experience.
