Healthcare Revenue Cycle Management: The Trial That Goes On and On!
The complexities of managing a physician practice revenue cycle have changed little over the years … and are still tripping organizations up. From the moment a patient enters the facility to the time the service is paid for, if RCM is not managed properly, it can lead to significant financial losses.
“The challenges of healthcare revenue cycle management have been around for ages. The problems are the same today as they were in the past – although technology has made the process easier, there are still many areas that need to be improved, said Kelvin Drawdy, a partner at JHD Healthcare Partners.
Opening Statement: Challenges of Healthcare Revenue Cycle Management
The challenges of healthcare revenue cycle management are numerous and can be divided into two categories: the administrative and the financial. Administrative challenges include managing patient data, scheduling appointments, collecting payments, and managing the billing process. Financial challenges include ensuring that payments are collected in a timely manner, and ensuring that the billing process is accurate.
In addition to these challenges, healthcare organizations also face the challenge of staying up-to-date with changing regulations and payer policies. This can be a difficult task, as the regulations change often and can be difficult to keep track of.
Finally, healthcare organizations also face the challenge of improving their cash flow. As the cost of healthcare continues to rise, it can be difficult for healthcare organizations to collect payments in a timely manner. This can result in delays in reimbursement and ultimately lead to financial losses.
The Causes of Revenue Cycle Management Trials
“The areas where we have seen little change in revenue cycle issues over the years are payer contracting, coding, denials, and cash collections,” said Drawdy.
To add on to these issues, each has its own set of challenges that needs to be managed properly in order to improve revenue.
Payer Contracting
Payer contracting is the process of negotiating contracts with insurance companies or other payers. It is a complex process, and requires careful negotiation in order to ensure that the contract is fair to both parties. It is also important to make sure that the contract complies with applicable regulations and laws.
Coding and Denials
Coding is the process of assigning the appropriate codes to procedures and services in order to ensure accurate billing. It is important to make sure that the codes are correct and up-to-date in order to avoid denials. Denials are when the payer rejects a claim due to incorrect coding or other errors.
Cash Collection
Cash collection is the process of collecting payments from patients and payers. It is important to ensure that payments are collected in a timely manner in order to ensure a steady cash flow. It is also important to set up a payment plan for patients who cannot pay the full amount at once.
Opportunities to Improve Revenue Cycle Management
There are several strategies that healthcare organizations can use to address the challenges of healthcare revenue cycle management. These include improving communication between staff and payers, streamlining the billing process, and using technology solutions.
Improving Communication
Improving communication between staff and payers is an important part of managing the revenue cycle. It is important to make sure that everyone is on the same page when it comes to policies and procedures, and that all relevant information is communicated clearly and promptly.
Streamlining the Billing Process
Streamlining the billing process is another important step in managing the revenue cycle. This can be done by automating the process, eliminating paperwork, and utilizing electronic medical records.
Technology Solutions
Technology solutions are becoming increasingly important for managing the revenue cycle. There are a variety of software solutions available that can help to streamline the process, reduce errors, and improve collection rates. These solutions can also help to automate the process and reduce paperwork.
Closing
Managing the healthcare revenue cycle can be a difficult task, and it is important to be aware of the challenges and develop and execute plans to address them.
“With the right strategies and technology solutions, healthcare organizations can ensure that their revenue cycle runs smoothly and to maximize their revenue,” concludes Drawdy.
JHDHP has over 20 years of experience helping physician and healthcare organizations diagnose the root causes of revenue cycle issues and work with leadership to fix them. If you’re practice is bogged down by revenue cycle challenges, contact JHDHP today to find out how we can help.