Revenue cycle management in hospitals refers to the steps that must be followed to ensure reimbursement for services rendered. This process includes everything from pre-registering a patient all the way through the final zero balance invoicing for a particular visit. Poor revenue cycle management can cost hospitals millions. Healthcare organizations of all sizes as well as the medical billing companies they partner with must stay abreast of the latest developments and changes in the RCM to improve the bottom line.
Healthcare revenue cycle management outsourcing is one of the key trends among healthcare organizations of all sizes, as providers and executives focus on reducing costs and increasing efficiencies. The Market Report estimates the global healthcare revenue cycle management outsourcing market to significantly increase, with its valuation rising from just $11.7 billion in 2017 to $23 billion by the end of 2023. This report also predicts that growth in this market will increase at a compound annual growth rate (CAGR) of 11.9 percent from 2017 to 2023.
Becker’s Hospital Review recently highlighted key predictions from vendors and hospital leaders on healthcare RCM, which include the following.
- Artificial intelligence will enhance revenue cycle
With innovative technologies now automating everything from patient registration to claims management and medical billing, it is predicted that more and more hospitals will be investing in artificial intelligence-driven automation. Advanced machine learning and other AI capabilities and functionalities can automate many of the processes in RCM, which dramatically increases effectiveness. AI can improve this difficult process of managing denial claims through grouping similar claims together, allowing collectors to adjust them all at once. Innovative, automated RCM infrastructures can also reduce the number of denied or underpaid claims for practices and cut back on operational expenses through increased efficiency, protecting their bottom line. This technology will also allow hospitals to free up their resources to improve human interaction with patients and put customer service at the forefront of revenue cycle management.
- Consumerism or patient care
Just like in any other business, consumerism plays a leading role in improving hospital revenue. As patients are savvy with the internet and online tools, they expect hospitals to communicate more efficiently and clearly. Convenience is a key factor in patient satisfaction. The first thing that can be done is to provide easy-to-pay options for patients. To avoid any issues regarding their payment and ensure a smooth payment process, patients should be informed about your billing procedures up front. Also, explain to them how much they are expected to pay from the start. Storing the records of patient’s credit cards in safe and secure mode can also speed up the payment process and make it easier for patients to pay their bills before/after every appointment. Providing payment plans with financing options could relieve some of the financial burdens for patients, who struggle to pay their bills up front. Appoint experienced and skilled staff to manage your patients and meet their increasing needs.
- Patient financial responsibility matters
Late and underpaid patient financial responsibility slows down healthcare revenue cycles. Consider optimizing patient collections by implementing point-of-service or pre-service payment options. Patient eligibility verification is critical and make sure you communicate with the patient about their portion of responsibility. Consider sending out information to patients indicating their responsibility via emails or patient portals.
Read our blog on collecting patient financial responsibility
- Denial management
Submitting claims to insurers with missing codes or incorrect codes could lead to significant revenue losses for the hospital. Make sure that you are appropriately reimbursed for the services provided and the supplies used. Identify under-reimbursed claims and in case of a claim denial, denial management must be typically conducted through collectors calling payers to follow up on denied claims individually.
- Track all details
As any hospital’s financial health is dependent upon claims being processed and paid as quickly as possible tracking is important. To ensure on-time reimbursement, it is crucial to track each and every detail you submit to the insurance company. Billing and coding accuracy should also be checked to improve revenue. Consider reducing mistakes that cause claims to be denied. Provide regular and consistent training for revenue cycle staff, which helps reduce billing errors. Revenue cycle technology platforms are now available that enable hospitals to track claims through their entire life cycle. Hospital finance and revenue cycle leaders can check when a claim is submitted for payment, when the payer accepts it and whether it was denied or paid, which allows to easily troubleshooting issues throughout the process.
Reliable accounts receivable or AR management services are provided by professional medical billing outsourcing companies, which educate their team members about each step in the revenue cycle, even if some of these steps fall outside their basic job description. Such companies are also prepared to meet any complex medical billing and coding requirements of any specialty.