Quick Start Revenue Cycle Management For Effective Administration Process!

Healthcare organizations rely on desperate administrative and clinical functions to optimize revenue cycle from beginning to end. They cater to three major areas – Patient access solutions, revenue cycle management and patient financial services. Pre- visit and post-visit services are the key component of patient centered medical service driving value to both patients and physicians in the revenue cycle management. It is within these operational services healthcare leaders capture critical information to process bill in an effective manner.

Under the ACA, hospitals’ uncompensated care costs dropped to the lowest levels nationally in decades. From 2000 to 2015, national uncompensated care costs reached a high of $45.9 billion in 2012, which represented 6.1 percent of total healthcare expenses. In 2015, uncompensated care costs totaled $35.7 billion, representing 4.2 percent of total expenses – the lowest level in 26 years. Claims management tends to be a fairly straightforward process when it comes down to proper execution. But when it doesn’t work things go really wrong. Complex claims can be so thorny, in fact that some hospitals even give up on them entirely. With such statistics and issues hiring a medical billing company is a very crucial decision and involves a broad range of evaluation factors. Medical bill experts charge a certain percentage on the money collected per month only after the healthcare organizations get paid. This is a good model if there are high level of denials and unclaimed amounts pending on the patients end.

Revenue cycle management has been playing an ever- increasing role in collecting some of the most complicated claims but the technology is only effective as the people who are in place once the systems has identified the denials. Finding the right revenue cycle management for healthcare services is based on value-based reimbursement models like the upcoming Quality Payment Program which breaks down the walls between care quality and healthcare payments. Revenue cycles management solutions include a gamut of services that can help organizations to optimize and automate business administration process, such as medical billing process, claims management, eligibility verification, claims denial management, audit services, provider enrollment and credentialing and predictive payments analysis.

Furthermore, the accuracy rate of billing services providers could have a huge impact on the receivables. Mistakes during the coding and billing stage could lead to costly delays and even denials. This results in fees receivables pile up on the docket; huge amounts of money that could have been reinvested into your practice. Thus a medical billing service might be offering you 2% of collections or just 10 cents per claim, but if you factor in other issues, you might be paying a much higher price.Additionally only about 40% hospital executives prefer to partner with a vendor for RCM consulting, followed by co management of 38% reported. Only about 5% fully want outsource revenue cycle management. While there is a lot to consider when selecting a revenue cycle management vendor, the market is expected to grow and change the new payments methods and with automation process between providers and payers the opportunity for market growth and diversity is projected to increase with value-based reimbursements.

Lastly depending on the size of the organization I think the ultimate question for hospitals is, can they take a long, hard look at their revenue cycle processes, and challenge themselves and their teams? You need to be willing to look at alternatives, and know what you’re good at and own that.