It is impossible to imagine a hospital or any healthcare facility where patient care isn’t the top priority. When it comes to a practice’s revenue cycle, it is all about putting your patients and the people driving your operations first.
As the healthcare industry trends shift from a fee-for-service to a more value-based reimbursement system, some interesting changes are coming about. One of the most significant changes is the transition from a traditional healthcare revenue cycle management system towards one that takes a more human-centered approach.
What is healthcare revenue cycle management?
Healthcare revenue cycle management consists of the financial processes that are used to manage both the administrative and clinical operations of a healthcare provider that are associated with insurance claims, payment collection, and revenue generation.
Healthcare revenue cycle management begins from the moment a patient makes their appointment with a healthcare provider till they make the final payment for their services.
When a patient makes an appointment, the administrative staff handles the scheduling, establishes the patient’s account, and verifies the patient’s eligibility for insurance. All of these processes are essential for the running of a smooth healthcare system. Once the patient has received their medical care, the healthcare provider must submit a claim for the service they have provided by identifying the nature of the treatment and using a specific CPT code.
Oftentimes these claims can be denied due to incomplete patient accounts, miscommunications, medical billing errors, or inaccurate coding of services, all of which leads to loss of revenue. This is why providers must ensure that their revenue cycle management process in medical billing is as airtight as possible to prevent any claim denials.
How to create a successful healthcare revenue cycle management system?
The healthcare industry is constantly evolving especially with the technological disruption taking place. For medical professionals running their own practice, the key is to keep pace in order to ensure sustainability and profitability. This is why healthcare organizations continue to look for ways to reduce their bad debts, prevent claim denials, and streamline their business operations.
However, the healthcare billing and payment system remains complex and often confusing and organizations struggle to make their accounts receivable management system more efficient. Medical practices that take a more holistic approach to healthcare revenue cycle management have much greater chances of efficiently acquiring patient payments and preventing denials while also meeting patient expectations.
Taking a human-centered approach to revenue cycle management in healthcare not only increases the likelihood of achieving a practice’s financial goals but also helps them drive efficiency.
To be successful at healthcare revenue cycle management, every healthcare organization must first assess and evaluate the services they provide to determine an appropriate financial structure that could maximize their revenue and limit unnecessary costs. But while doing so, they must also think holistically about the kind of experience they are trying to provide to their patients.
A revenue cycle management system that focuses on providing a better experience for everyone involved in the process helps healthcare organizations boost their revenue integrity, achieve performance goals, eliminate errors, and apply metrics to become more efficient and earn more accurate reimbursements.
There are two aspects to a successful revenue cycle management model that needs to be taken into account when thinking of taking a human-centered approach to this task:
1. Patient experience
As mentioned previously, the process of revenue cycle management begins when a patient makes an appointment to seek medical services and then follows and tracks the financial elements of each step in the patient’s treatment. It is important to acknowledge that the patient’s experience is at the crux of a successful medical practice.
The patient’s experience begins even before they enter your facility and seek medical care. Pre-visit revenue cycle management processes such as appointment booking or demographic collection can also negatively impact a patient’s experience if not handled with care.
Today, patients expect a transparent healthcare system with simple billing and payment processes. This is why several healthcare organizations turn to technology solutions to enhance their revenue cycle management processes in medical billing.
State-of-the-art tools such as AI, machine learning, and predictive analytics can help healthcare providers streamline their activities and be better equipped to offer a consumer-oriented approach to healthcare revenue cycle management.
By automating tasks such as insurance eligibility checks and booking appointments, the revenue cycle staff can better cater to the patients and provide them with the necessary information they need more efficiently and quickly. More advanced technological solutions such as predictive analytics can also help patients make better data-driven decisions about their healthcare and improve patient engagement.
Today, patients can access digital healthcare platforms where they can access all their healthcare information in one centralized location. From booking appointments to payment collection, healthcare providers must eliminate any sort of friction during patient interactions to improve their revenue cycle management system.
2. Staff experience
While the financial health of a healthcare organization depends significantly on the experience they offer to their patients when providing care, many providers overlook optimizing the experience for their front-end and back-end staff. Improving their workflows is integral to healthcare revenue cycle management.
Additionally, it is also equally important to look for ways to bring together different members of staff from different departments so that work collaboratively to build a stronger revenue cycle.
When the revenue cycle management process in medical billing is supported by innovative technological tools, there are lesser chances of errors which reduces the burden on your administrative staff to correct those errors.
The use of modern technology such as cloud solutions and digital service integrations also eliminates the need to juggle multiple tools for your employees. This, in turn, allows them to be more engaged with their patients, resulting in a more enhanced patient experience.
Whether it is facilitating patients through the billing process or making insurance claims from payers, the revenue cycle team plays a key role in boosting your healthcare organization’s financial standing. With the added support of tech tools, your healthcare revenue cycle management team has the opportunity to work collaboratively to boost productivity within your operations.
The bottom line
All hospitals and practices want to improve their financial standing while continuing to provide the best care possible to their patients. And the first step towards doing so is delivering a more human-centered healthcare revenue cycle management system which begins with creating an effective and comprehensive strategy that could strengthen the foundation of a practice’s finances. But for this strategy to be successful and to reap benefits for both patients and providers, it must keep the human elements of the revenue cycle a priority.