As the healthcare industry transitions from fee-for-service models to value based approaches to tackling rising costs, revenue cycle management takes on much greater significance. From pre-registration to collections, the dynamics of your revenue cycle depend on a myriad of key factors. Your hospital or healthcare institution may be dealing with largely external forces including patient debt, decreased cash flow, and increased claim denials from a volatile health insurance market.
Without cutting corners and affecting care quality, how can you improve your RCM in the ever-evolving healthcare universe? Don’t miss these 9 tactical and effective solutions:
Use Revenue Cycle Management (RCM) Software
Digital RCM solutions can streamline and automate processes, maximize profits, and even provide insights into patient populations including rates of illness and chronic disease, frequency of visits, ability to pay, etc. Integrated into other health IT systems including medical records and billing, effective RCM software shortens the window of time between providing service and receiving payment. It can also assist with tasks like scheduling appointments, reminding patients of outstanding balances, and even automatically responding to payer claims denials with questions and appeals. Continue reading
An article in Healthcare IT News stated that 10% to 20% of claims that are denied can contribute to approximately 90% of missed revenue opportunities. However, a company experienced with RCM is able to maintain quality procedures and measures that keep pace with today’s ever-changing business needs and reimbursement models.
According to the Northern California Spring Conference, California health insurers rejected approximately 1 in every 5 medical claims, approximating $45.7 million in missed revenue between 2002 and 2009 alone (and that doesn’t include claims denied by Blue Shield of California).
Even more alarming are their statistics that a managed care hospital with a net revenue of $50 million may have – at any given time – $5 to $10 million in an open state of denial. Read more
There’s no denying that the digital revolution has spawned an age of convenience, but with that convenience comes a growing concern for the security of consumer information.
This rings especially true for healthcare organizations that are responsible for mountains of patient information.
A stolen credit card can be canceled, but a medical record contains significantly more rich data and information about a person. These records contain family information, financial information, and of course, a medical history. “A person’s health information is worth 15 to 20 times more than financial information,” said Robert Wah, MD, President-elect of the American Medical Association and Chief Medical Officer for CSC, a health IT Company in Falls Church, VA.
Lisa Gallagher, Head of Privacy and Security at HIMSS agrees. “It’s easier for identity theft to take place from a medical record that’s not secure than it is from a financial record because they tend to be locked down a little better. Hackers and other perpetrators have moved to trying to get it from the medical record.”
All healthcare organizations, including urgent care centers, must educate themselves about health IT security so they can better protect their patients.
With this in mind, here are 4 things you should know about health IT security. Read more
Finding the right partner
Use services like KLAS to find top-rated vendors.
Is the EHR certified?
Does the EHR adapt to my workflow?
Will the new solution fit my budget?
Planning the implementation
Use a detailed project plan that lays out tasks and milestones clearly.
Leverage your partner’s expertise to bridge the gap between your current state and best
Practice. Read more
When asked what the key to success is, most business owners will tell you the ability to stay competitive in the marketplace. Staying competitive is particularly important in the health care field where the financial success of a physician practice is fundamentally based on provider productivity and revenue cycle management. A practice that’s unable to reduce revenue leaks and increase their bottom line will have a hard time staying afloat.
When it comes to minimizing costs and managing revenue, medical practices of all sizes make the same mistakes. Here are 7 common RCM pitfalls to avoid at all costs.
Not Collecting at Point of Service
Not everyone is comfortable collecting from patients at point of service (POS), but avoiding this sometimes-difficult task can put your practice’s revenue at risk. You know firsthand that copays and reimbursements are a major part of how you and your staff get paid.
Should a payment not occur at POS, a lot of time and money is spent following up and chasing after patients. There are the endless phone calls and emails and paper invoices, and all of those “minor” expenses add up, not to mention the expense of having to hire a collections agency. Multiply these expenses by “X” number of patients and your revenue soon develops a slow and steady leak.
The moral of this RCM scenario is, it’s much harder to get patients to pay once they’ve been treated and are out the door, so make sure your staff has been trained on these procedures and can clearly communicate your collection policies. Read more
MIPS (Merit-Based Incentive Payment System) delay & shorter reporting periods are the options CMS is willing to explore.
- On July 13, at the congressional hearing on the Medicare Access and Chip authorization act, CMS Acting Administrator Andy Slavitt did not rule out the possibility of a MIPS delay.
- Originally, MIPS is scheduled to start from January 2017 with payment adjustments beginning in 2019.
- Since the release of the proposed rule, various physician groups have called for greater flexibilities, many of Which center around pushing the start date forward by at least six months.
- With the final rule scheduled to release on November 1, leaving physicians with only two months to prepare CMS is Open to give physicians more time, said Slavitt. Read more