As with any business, healthcare providers must deal with the nuts and bolts of getting paid so that the business can continue to function and serve people. But in healthcare, revenue cycle management is complicated by a number of factors, including strict regulations, an ever-evolving payer mix, and consumers who are dealing with shouldering more of the cost of their care themselves.
Effective healthcare revenue cycle management is an ongoing process, and healthcare providers that pay insufficient attention to it can count on facing financial and operational difficulties. Following are some of the top questions and answers about revenue cycle management in the demanding healthcare industry.
1) What Are the Essential Components of Effective Revenue Cycle Management?
The exact technology and personnel mix that makes one facility's revenue cycle management tick may not be right for another. However, there are some common factors that set effective revenue cycle management apart. Generally speaking, effective revenue cycle management is streamlined, and that usually means deployment of software that automates processes. Web-based services that patients can use to deal with the billing cycle and get answers they need are increasingly becoming indispensable to providers. Real-time insurance verification is another streamlining measure that pays off in time savings and avoidance of confusion. Revenue cycle management systems with built-in "rules engines" help prevent errors and can provide important information about things like co-payments and potential errors in insurance claims before they happen.
2) What Is the Biggest Obstacle to Good Revenue Cycle Management?
Becoming mired in what worked in the past is perhaps the biggest obstacle to effective revenue cycle management today. Not only are billing and collecting via paper statements slow, they don't take into account the changing nature of reimbursement. More consumers are shouldering a bigger proportion of their medical bills, and healthcare providers must now focus more on patient balances after insurance payments. Healthcare facilities must also avoid thinking that operational necessities (like implementing electronic health records) are the same as a competitive strategy. Technology upgrades may be necessary for a better competitive position, but they're not sufficient.
3) Is Outsourcing a Smart Solution to Revenue Cycle Challenges?
The administrative burden on healthcare facilities continues to increase, and many practices (including smaller facilities with limited resources for hiring) find that outsourcing some or all revenue cycle processes, like claims submissions and patient billing, is the right solution. As just one example, claim denial is a common problem for many facilities, yet many facilities don't have the personnel or resources to rework claims, and examine trends to prevent future denials.
Outsourcing claims submission can produce a strong return on investment while freeing hiring dollars to go toward medical, rather than administrative staff. With the major change of ICD-10 just this past month, outsourcing is looking more attractive to many practices as they seek to minimize disruption.
4) What Does the Near Future Hold for Revenue Cycle Management?
One of the most important revenue cycle management challenges many providers will face is the increase in focus on individuals as purchasers of health insurance and healthcare services. This more accountable consumer requires a different focus for practices that have long focused on insurance reimbursement. While the need for attention to third-party reimbursement hasn't gone away, healthcare consumers themselves will be providing a bigger chunk of providers' income. The transition to ICD-10 alongside Medicare payment models that demand more documentation and the shift toward value-based reimbursement will demand the attention of healthcare revenue cycle specialists in 2015 and beyond.
Conclusion
Revenue cycle management is the key to success in any business, and in the healthcare business, the process is complex and subject to frequent change. Healthcare facilities can cope with these challenges in numerous ways, such as investing in automation technology, remaining open to new technology solutions, outsourcing some or all revenue cycle management tasks, and focusing more on the individual consumer's role in the healthcare revenue cycle.
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