Traditional revenue cycle management strategies are on shaky ground. Time-consuming manual processes are struggling under the burden of increasing patient volumes and patient financial responsibility. Clunky interfaces and disjointed systems fall short of evolving consumer expectations. Understanding and adapting to sweeping regulatory change is challenging for understaffed teams. On top of all of that, the pandemic continues to send tremors through the financial landscape, prompting many providers to review their ability to manage increasingly complex claims and collections.
Given these challenges, providers will benefit from making it as easy as possible for staff and patients to navigate financial touchpoints throughout the patient journey. Data and analytics, digital tools and automation facilitate smoother payments, fewer denials, and reduced staff involvement.
The following revenue cycle management checklist is designed to help healthcare organizations assess the health of their revenue cycle. That way, healthcare providers can find opportunities to increase cash flow and provide a more compassionate patient experience.
Is patient access automated?
- Can patients book appointments online?
- Does the online scheduler automate business rules to guide patients to the right provider?
- Are patient identities verified at registration and point of service?
A healthy revenue cycle starts with quick, accurate and efficient patient access processes. Digital tools and automation improve the pre-service patient experience by making it easier for patients to book appointments and register for care. By creating a smoother workflow, online self-scheduling and self-service registration can also save on staff time and resources, and minimize the costly errors that creep in with manual systems. Moving away from paper-based prior authorization processes can further increase operational efficiency and prevent denials, so healthcare organizations can get reimbursed even faster.
Are patient collections optimized with data and analytics?
- Are patient estimates provided upfront?
- Are notice of care requirements being addressed?
- Are patients offered appropriate financial plans and easy ways to pay?
High deductible health plans are placing more financial responsibility on patients, which puts patient collections under the spotlight. The best practices for patient collections center around price transparency and easy payment methods. When patients know upfront what their portion of the bill is going to be, and have multiple payment methods to choose from, they’re more likely to pay in a timely way. Patient Payment Estimates offers patients clear, accessible estimates of their financial responsibility before treatment. Those that need financial assistance can be directed automatically to payment plans and charity options.
A survey in June 2021 revealed that providers were feeling more confident about collecting payments from patients compared to the year before, but still found checking for coverage to be a challenge. With Coverage Discovery, healthcare organizations can run checks across the entire revenue cycle to find billable commercial and government coverage that may have been forgotten, to maximize the chance of reimbursement.
Is claims management workflow automated to reduce denials?
- Are high-impact accounts prioritized?
- Are remittances reconciled with payments received?
- Does claims management software generate real-time insights and reports?
With 69% of healthcare leaders seeing an increase in denied claims in 2021, finding more efficient ways to process claims and prevent avoidable denials is paramount. Healthcare organizations can improve their revenue cycle with automated claims management to reduce errors, prevent undercharges, and submit clean claims the first time. ClaimSource allows the entire claims cycle to be managed in a single, web-based application. This tool integrates national and local payer edits with custom provider edits to verify that each claim is properly coded before being submitted. By focusing on high-priority accounts, providers can target resources in the most effective way to ensure a higher first-pass payment rate.
Alongside this, data-driven tools such as Claim Scrubber can automatically identify claims that have been previously denied and why. This helps to predict and prevent future denials. Not only can this automation increase cash flow, but it also reduces time-consuming back and forth with payers.
Is the organization staying on top of payer contracts to increase timely reimbursements?
- Are there robust processes to audit payer performance?
- Are staff informed of changing payer requirements?
- Are relationships with payers built on solid communication and two-way accountability?
A healthy revenue cycle relies on healthy payer-provider relationships. Any mismatch between expected and actual payments is a double blow to provider profits, through missing revenue and time spent reprocessing. Reliable healthcare contract management solutions can ensure providers are reimbursed quickly and accurately. Various digital and automated tools are available to notify providers immediately of any changes to payer policies or procedures, so payment delays can be avoided. They can continuously audit payer performance and ensure collections align with negotiated terms to prevent under- and over-payment. Perhaps most importantly, contract management tools help providers and payers to communicate more effectively, so providers know exactly what payers need for quicker revenue recovery.
From “surviving” to “thriving”
While there are multiple digital tools and technologies available for revenue cycle management, the key success factor is to design the revenue cycle strategy around what patients need most. When the financial journey is clear, consistent, transparent and compassionate, patients will be more likely to manage their bills, and providers can collect what they’re owed much faster.
Discover how to run a revenue cycle health check and see where digital tools, predictive analytics and automation can help improve the patient experience and optimize financial operations.