How Can Revenue Cycle Management Streamline Your Healthcare Collection
The financial revenue process utilizes medical billing software. The healthcare facilities track patient care episodes from registration and appointment scheduling to the final balance payment. Revenue Cycle Management unifies the business and clinical sides of healthcare by coupling administrative data.
With such a patient’s name, insurance provider, and other personal information, with the treatment, a patient receives and their healthcare data. Communicating with health insurance companies is a critical component of RCM. When a patient schedules an appointment, the physician’s office or the hospital staff typically checks the patient’s received treatment for a given condition and supplies any applicable copayment; a healthcare provider will categorize the nature of the treatment.
The hospital or care facility then sends the care summary with ICD and current procedural technology codes to the insurance company to see what portion of the care will be covered by insurance, with the patient billed for the remainder.
The revenue cycle covers all the administrative and clinical functions that contribute to capturing, managing, and collecting patient service revenue as per the Healthcare Financial Management Association (HFMA).
Here is what’s involved in the revenue cycle:
Charge capture: Rendering medical services into billable charges
Claim submission: Submitting claims of billable fees to insurance companies
Coding: Properly coding diagnoses and procedures
Patient collections: Emphasising coding diagnoses and procedures
Patient collections: Determining patient balances and collecting payments
Preregistration: Collecting pre registration information, including insurance coverage, before a patient arrives for inpatient or outpatient procedures
Registration: Collecting the following patient information during registration when establishing a medical record number and meeting various regulatory, financial, and clinical requirements.
Remittance processing: Applying or rejecting payments through remittance processing.
Third-party follow-up: Collecting payments from third-party insurers
Utilization review: Examining the necessity of medical services
What affects revenue cycle management?
There are external and internal factors that affect how revenue is collected. A healthcare debt collection agency can exert some control over internal dynamics. This includes external factors such as patient payments or claims reviews from insurance companies.
Healthcare providers often purchase and deploy designated revenue cycle management companies to store and manage patients’ billing records. An effective revenue cycle management system will help reduce the time between providing services and receiving payment by interacting with other health IT systems. This may be in the electronic health record and medical billing systems as patients move through the care process.
An RCM system can also save healthcare organizations time when automating duties that employees previously handled. These duties include administrative tasks, including informing patients of upcoming appointments, reminding payers and patients of an existing balance, and reaching out to insurers with specific questions when a claim gets denied.
Healthcare revenue cycle management can also save providers money by giving them insight into why claims have been denied. For example, an RCM system can cut down on denied claims when prompting healthcare employees to enter all the information required for claims processing. This saves them from revising or resubmitting the claim and gives providers better insight into why specific claims have been denied, thereby enabling them to rectify the issue.
It also ensures that providers are appropriately reimbursed for caring for Medicare patients. An organization will purchase data analytics software, use dashboards, and set and monitor revenue goals. The organization can visualize where its revenue cycle has room for improvement by sorting billing data and producing corresponding reports.
Third-party healthcare debt collection agencies also run technologies, including cognitive computing, to help ensure the correct medical codes are assigned to the correct patient and robotic process automation to help speed up the process.
RCM and value-based care
Some experts believe the RCM system will help transition the industry from fee-for-service to value-based reimbursement. The analytics also involved in many of these RCM systems allow payers and providers to experience getting a more detailed look at their patient population, including what portion of their patient population is suffering from chronic diseases, as well as allowing them to monitor the claims data and pinpoint any abnormalities.
This is particularly important given the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), a piece of recent legislation pushing healthcare towards value-based care and reimbursement.
Revenue cycle enhancements through automation
Automation is an integral part of the collection. However, many healthcare leaders agree that it can enhance revenue cycle management. Besides, the healthcare system executes RCM as the area most needed for innovation and disruption.
RCM is resource-intensive and needs to be more easily scalable for large organizations. Rather than simply throwing more bodies or hours at the problem, it’s more about the expense of the patient experience-providers are looking for smarter, most cost-effective solutions.
Focus on innovation and disruption
The very nature of RCM makes it a good fit for automation technologies. The focus is on.
- Resource-intensive, meaning automation offers significant savings potential
- Transaction heavy: Unlike retail, RCM involves multiple customer transactions to receive payment, from initial scheduling to submitting a clean claim
- Overly complex and manual but primarily based on repetitive steps and transparent rules
Automation is particularly good at handling tasks with codified rules and processes. An effective revenue cycle management includes manual and repetitive tasks that could be automated.
Increased focus on patient experience and customer service is another driver of RCM disruption. To create a patient-centric environment, staff must be free to focus their attention on patients. In addition, automation can reduce repetitive manual work and redirect valuable workers to higher-value tasks.
Robotic process automation
Healthcare debt collection agencies are now investing in RPA. It uses specialized computer programs called robots to automate repeatable processes. These bots are designed to handle straightforward, repetitive, rules-based tasks and perform the same way every time.
RPA does not replace human-problem solving. Instead, bots can act as virtual helpers, allowing human workers to offload repetitive tasks that don’t require analysis or intervention.
Benefits and potential use
RPA is ideal for tasks that aren’t complicated but takes a lot of time. This frees up human workers for more value-added and patient-centric work. Bots run 24/7, 365 days a year, with no need for breaks, and can perform their tasks an estimated 5 to 20 times faster than a human.
RPA also reduces human error. After performing the same task repeatedly, even the most meticulous humans will sometimes make an error-transposing a number when carrying over information. Revenue cycle management uses RPA bots programmed to perform a specific task the same way every time. They need to learn or adapt more innovative ways to perform the task or solve problems. AI can provide the next level of automation.
Artificial intelligence (AI)
AI involves the use of intelligent computer systems to simulate human intelligence. These processes include learning (taking in information and applying contextual rules for using it), self-correction (learning from successes and failures), and even reasoning (reaching conclusions by applying context and rules). AI does this by using algorithms that identify patterns and plans future actions.
If you’ve ever used a chatbot on a website, Alexa in the home, or Siri on the smartphone to get answers to a question, you’ve encountered AI. Typical applications include machine learning, image recognition, speech recognition, natural language processing, and translation.
Benefits and potential use cases for AI
AI is already well established in clinical use but is in the early adoption stage of RCM. However, this will soon change. Healthcare leaders are still exploring the specific ways this advanced technology can help improve both financial performance and the patient experience.
AI can work with RPA to create what is known as end-to-end or “unattended automation. While RPA uses preprogrammed logic to handle structured data, including entering numbers on a form, AI creates its logic and can handle unstructured data, like free typing in a chatbot or textbox or analyzing speech in a phone call.
Healthcare RCM involves both kinds of data. This includes combining RPA and AI. It’s possible to automate an entire process from start to finish. One of the best examples of this combination is prior authorizations, one of the most burdensome RCM tasks. RPA bots can carry out the repetitive tasks usually performed by the staff during the authorization process, while the staff can perform AI during the authorization process. At the same time, AI can learn from historical denials to anticipate changes and potential flag issues.
While AI can automate many processes, it doesn’t eliminate the need for human workers. AI can get the correct information to the right person at the right time when human intervention is needed. Patients may prefer automated methods for basic tasks. However, they still want a natural person to help during “moments of truth”- interactions that involve solving critical issues or making care decisions.
Enhanced profitability and patient experience
The power of lower operational cost has providers jumping at implementing the latest AI technology, and there is no lack of options. Meanwhile, it’s essential to be highly intentional when choosing and implementing automation. Besides, it isn’t about cutting labor costs but is more focused on freeing staff for valuable patient-centric work. When applied strategically, this helps reduce operational costs while improving the patient’s financial experience and staff morale.
Revenue cycle management companies can help you get the best possible return on all your investment with practical solutions.
Healthcare CFOs are now focusing on revenue improvement when finding opportunities to change the status quo. With the coordinated process, collaborative team structures, efficient tech, effective measurement processes, and great partners, the strategies can adopt to bring about dramatic improvements in the financial health of their healthcare entities.