Optimize Revenue Cycle Operations to Improve Claims Management and Reimbursement

by Outsource Strategies International Medical Billing Company Healthcare revenue cycle process includes many things ranging from determining patient eligibility verification, collecting their co-pay, coding claims correctly, tracking claims, collecting payments and following up on denied claims. Major reasons for financial trouble in a hospital include medical billing and collection errors, health IT challenges, lack of staff training, poor insurance eligibility verification, failure to monitor the entire claims process, and lack of financial policy documentation in place.

Successful Revenue Cycle Management (RCM) results in lower bad debt expense, reduced operating cost, and improved productivity. The effectiveness of a hospital’s revenue cycle drives the entire hospital operation. Poorly managed revenue can lead to a significantly lower profit margin, clerical errors, problems with insurance providers and shortage of staff to fulfill requirements. Revenue cycle operations include rendering a service, billing for the same and collecting reimbursement. RCM measures how well a hospital maximizes the amount of patient revenue billed and how quickly it collects that revenue.

There are several key areas that revenue cycle specialists could focus on to ensure their medical facility optimizes reimbursement.

* Patient education plays a key role - Better patient engagement can benefit your hospital’s revenue cycle. By training staff to collaborate with patients and to educate them early in the process of treatment will help to manage bad debt avoidance. Thus patients are not stupefied when they receive a medical bill after discharge or a medical appointment. Cost transparency is also an important part of improving patient communication. Now patients are requiring hospitals and clinics to offer real cost information before agreeing to medical services. The patient should be informed if the providers are not in the insurance network.

* Invest in staff training - A well-trained staff can reduce billing errors and make the entire process of billing more efficient.  Providing training to all staff members is crucial. According to AHIMA, it is a must to have at least two staff members thoroughly trained (including ongoing training when the system is updated) and knowledgeable about the functionality of the system. Although training might be costly and time consuming, it can save healthcare organizations money in the long run. Coding errors are similar to medical errors, which cause unnecessary spending. According to a recent study published by patient safety experts at Johns Hopkins, medical error is the third leading cause of death in the U.S.

* Have financial policies – A financial policy can serve as a helpful tool for healthcare professionals involved in billing. Along with processes for analyzing the financial capabilities of a patient, it could also include steps for determining a patient’s balance and even information regarding denied claims and how to address them. According to AHIMA, the financial policy should provide guidance to patients regarding collection of co-payments and unpaid balances, patients’ responsibilities regarding insurance requirements and supplying insurance information, the medical practice’s accepted payment (cash, credit card, etc.), and more.

* Invest in health IT - Investing in health information technology is also crucial in the current environment, as it can keep track of claims through their entire lifecycle. A successful revenue cycle process also relies on technology and software that supports the data collection related to the medical billing event.  As per the ReportBuyer’s study, growing investments in healthcare IT and consolidation of healthcare providers are major factors influencing the growth of the global revenue cycle management market. The report predicts that the market is expected to reach USD 7.09 billion by 2020, at a CAGR of 11.8% from 2015 to 2020.

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Created on Dec 31st 1969 18:00. Viewed 0 times.

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