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The Interoperability of an End-to-End RCM Solution

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Interoperability is the operative word in healthcare and with good reason.

Though the concept of interoperability is not new (the word itself was coined in the 1960s), its evolution is deeply tied to healthcare. And emphasis on its practice within the healthcare industry — from private-practice physicians to hospital systems to home health and hospice providers — has grown in recent years as organizations seek to meet mandated electronic health record (EHR) standards and attempt to maintain and build revenue amid tumultuous circumstances.

At its most fundamental, healthcare interoperability is the capacity of two or more IT systems to securely exchange, process and use information. On a broad level, the path to healthcare interoperability entails fully interoperable health organizations nationally, a project years in the making and many more from completion.

Achieving interoperability begins with basic data collection and enabling automation or automation assistance for specific tasks in order to improve the accuracy and efficiency of data transfer and interpretation. Interoperability, or a lack thereof, has far-reaching impacts on patient care and an organization’s revenue cycle.

Implementing an end-to-end revenue cycle management (RCM) solution is a significant step toward attaining a genuinely interoperable health system.

The Drive for Healthcare Interoperability

Interoperability is more than a buzzword. It’s a necessity in today’s healthcare climate.

Healthcare interoperability hinges on the adoption of electronic health records, which a majority of hospitals and physicians accomplished by 2017. Yet, in a 2019 survey of chief financial officers and revenue cycle executives, more than 60 percent said their hospitals and health networks had not experienced lower costs and improved patient experience relative to their EHR systems. Another recent survey found that nearly half of acute care providers and almost one-third of post-acute providers have limited ability to access or share EHRs.

Several factors fuel the renewed focus on interoperability. The pandemic has overextended healthcare teams, and the healthcare industry has been among the hardest hit by the mass job departure known as the Great Resignation. Meanwhile, the demand for home health and hospice care has soared as the number of skilled workers dwindles.

These challenges have contributed to medical coding errors, faulty claims data and surging claim denials. The result, for many organizations, has been an upended revenue cycle and thousands to millions of dollars in losses.

An RCM solution built for interoperability can fill many of the gaps responsible for limiting access to EHRs, slowing the claims process and clogging revenue streams. It delivers levels of accuracy and efficiency that outdated technology and patchwork staffing services cannot.

Interoperability and the Healthcare Revenue Cycle

A comprehensive RCM solution provides interoperability at levels that allow organizations to cope with the current challenges that contribute to medical coding errors, inadequate claims data, claim denials, delayed reimbursements and other complications that impede the revenue cycle.

Interoperability should be considered at every step of the patient journey and every phase of the revenue cycle. Both begin with patient preregistration or prior authorization. This crucial step allows providers to gather vital patient demographic data for the patient’s EHR as well as insurance information to determine payer eligibility.

Capturing accurate data upfront streamlines the actual registration process, in which providers verify insurance, collect copayments and ensure any applicable referrals are in place. An end-to-end RCM solution can share and update related data and flag missing or inadequate information.

Effective interoperability in these early stages sets the stage for fluid charge capture and claim billing, both of which present opportunities for automation within a fully integrated RCM platform. For example, patient data and treatment information can be programmed to automatically flow into the billing process.

Certain medical coding tasks can also be fully or partially automated to reduce the burden on internal staff and improve coding accuracy. A comprehensive RCM solution also makes it easier to monitor for miscoded charges or missed charges.

Interoperability should carry over to claim scrubbing and claim submission. Communicating accurate data from prior authorization through claim submission increases the chances for clean claims, and clean claims lead to faster reimbursement.

An interoperable RCM solution can help identify potential coding discrepancies before claim submission and track claims from submission through remittance. It can also alert to inconsistencies in submitted claims and remittance statements.

Interoperability Within an RCM Solution

Interoperability relies largely on digitization, although people remain integral for oversight and other essential functions. An RCM solution built for interoperability improves the speed of data sharing and processing and the quality of data.

Such an RCM platform improves care coordination by assisting with scheduling and communicating patient data between intake, care providers and payers without recollecting the same information at each step. An interoperable system also better protects the security of that data than legacy health information management systems.

Privacy is a paramount concern as health organizations evaluate where protected health information (PHI) lives and with what sources it is shared. When patient data is entered into one system that is not linked to another that utilizes the same information, it becomes problematic to trace the multiple systems that hold PHI in accordance with HIPAA standards.

The secure sharing of data also leads to another of the many benefits of an interoperable solution: better overall public health information. When systems can exchange data, they can also yield insights that affect patients, providers and payers.

A state-of-the-art RCM platform features predictive analytics and other tools to help healthcare leaders make assured, data-driven decisions regarding patient care plans, medical coding and billing strategies, staff productivity, and claims management. An interoperable system can also help reduce costs and increase profits.

An analysis presented to the U.S. Congress in 2013 by the West Health Institute found that medical device interoperability alone could save the national healthcare system more than $30 billion annually. That research focused solely on the ability of medical devices such as electrocardiographs, infusion pumps and vital-sign monitors to relay and exchange information with other health IT systems. A look at the bigger picture reveals even greater possibilities for cost savings and revenue growth.

An integrated RCM platform further extends interoperability by bridging technological and human resources. It includes not only advanced technology, but also extended business office solutions such as experienced medical coding and billing teams, telehealth capabilities and patient-access resources.

Interoperability has long been discussed as a distant goal, and it certainly is at the national and global levels. But it is also an attainable goal for hospitals and health systems with the right partner at their sides.

About GeBBS Healthcare Solutions

GeBBS Healthcare Solutions is dedicated to helping healthcare providers and payers achieve interoperability through services that optimize the revenue cycle and enhance patient satisfaction.

GeBBS is a leader in healthcare technology and third-party solutions. GeBBS has earned renown for its scalable health information management, revenue cycle management and extended business office solutions, which are designed to provide confidence and deliver results for our partners.

GeBBS is rated as one of Modern Healthcare’s Top 10 Largest RCM Firms, Black Book Market Research’s Top 20 RCM Outsourcing Services and Inc. 5000’s Fastest-Growing Private Companies in the United States. Visit gebbs.com today to learn how GeBBS can help your organization.

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