There has always been an interest in Revenue Cycle Management (RCM) because healthcare organizations continually face delays in receiving payments that can often be measured in months. Uncertainty surrounds most of the healthcare payment process, and providers are looking to revenue cycle optimization as one way to regain control.
Healthcare is one of the few businesses where you sign a contract and don’t know when or what you will be paid. While such ambiguity has always been part of healthcare, providers today are under more financial pressure and have less margin for error. The cost of providing care is rising for all healthcare organizations, and payment rates are declining from many payers.
Improving the revenue cycle is growing in importance for almost every healthcare provider. Gone are the days when you could afford to have an inefficient revenue cycle.
Providers’ approaches and strategies surrounding revenue cycle management have also changed. In the past, there was a focus on the front-end, a preventative perspective. Then, the focus shifted to the back-end, like the billing and collections process.
Today, healthcare administrators aren’t interested in fixing the revenue cycle
on a piece-meal basis; they’re looking to fix the entire process of revenue cycle management.
Hospitals and physician offices are particularly working on improving the claims submission process. This problem continually plagues providers in that more than a third of all claims submitted are denied on the first pass. This drastically drives up the cost of health administration.
A unified approach to revenue cycle optimization has to involve more than one strategy for healthcare organizations. It also has to involve more than just technology, which can be implemented, but not used. Improvement is also related to revising workflow processes, fine-tuning charge capture practices and paying more attention to customer service.
Workflow is crucial because it can enable facilities to check on a patient’s eligibility before he or she presents himself/herself for care. If patients aren’t insured or are not covered for particular services, then providers can make payment arrangements with them before care is delivered.
Charge capture, of course, is critical and it has gotten an assist from technology, automated charge capture allows staff members to assign billable charges to patients as they receive care. Technology also can help retrospectively in diagnosing where charges may have been missed and identifying who on staff may be missing charges consistently.
Customer service is also getting attention in the revenue cycle management process from providers, who are realizing the importance of improving relations with patients. Usually, the first person and the last person a patient talks with is from the revenue cycle staff. Some hospitals are using these people as ambassadors. The first person at the front door can help shepherd them through the system. A hospital could provide the best care in the world, and it’s all comes to nothing, if patients are getting 17 different bills that they don’t understand.
As pricing transparency and high-deductible plans grow in importance, it will be even more important for healthcare organizations to improve revenue cycle management.
Transparency is being advanced from the highest levels of government, and patients are increasingly responsible for a higher portion of their bills, so it makes sense to give them a good idea of what their bills are going to be, and either receive or make plans for payment for care.
To improve revenue cycle management, providers are turning to technology and companies who specialize in optimizing this process. They are also adding “bolt-on” technologies to help with particular aspects of the billing cycle.
Be sure when you tackle this important challenge, you enlist the services of a company that offers a holistic solution to revenue cycle management.