Understanding and optimizing the revenue cycle is not easy. There are so many activities and steps pertaining to all administrative and clinical functions within healthcare, that the ability to capture, manage, and collect patient service revenue can seem daunting. Gaining an effective capability to do so requires that healthcare providers achieve revenue cycle readiness by examining and mapping each step from patient admittance to the release of their final bill. Each step in between represents a piece that leads to a complete revenue cycle. Successful and profitable healthcare institutions often have a firm grasp on every individual step, including visibility into the revenue cycle as a whole.
Another key to meeting the challenges to revenue cycle readiness is the clinical backbone of a hospital’s IT systems: the electronic health record (EHR). Ensuring that the EHR is in sync with the financial systems drives effective inventory management and ensures that inventories are kept up to date. Tying the EHR to the inventory system can also help maintain the level of attention concerning proper documentation which then drives the proper coding, billing, and charging, on the back end.
It’s also important to note that there is a myriad of assistive technologies that can help with coding, documentation, and verifying addresses or insurance. This technological tie-in is a key step in minimizing human error, which is common whenever there is a human interaction with the patient at the frontend during the information collecting phase. To address this issue, there are a lot of new technologies geared towards ensuring that the appropriate responses are put into the system, the appropriate authorizations happen, and the right information follows the patient through their continuum of care.
According to an article in Healthcare Finance magazine, the top five reasons for claims denial are duplicate claims, a lack of information, expiration of eligibility, claim not covered by insurance, or a time limit expiration. This trend signals the impact that these issues have on causing significant revenue issues for healthcare providers—issues that could be mitigated by making sure a robust process is in place when the patient enters a facility.
These tips also signal the need for finance mangers to modulate concerns about getting the net revenue numbers correct within their financial statements when it can often be ineffective in optimizing the revenue cycle. This fact seems even more important considering that with digital transformation, most healthcare providers are experiencing the delivering of denials or payments faster than ever.
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Since so much information is gathered from the patient after their treatment during the billing phase, healthcare organizations need to move away from the old system of thinking about the numbers, and start to think about the whole revenue cycle and different technologies that may help avoid problems throughout the cycle. This has the potential to produce significant opportunities for healthcare providers and make a significant difference that adds value for patients.