One can’t deny the fact that the ongoing pandemic has exposed the loopholes in the financial and revenue cycle management strategies. Due to the lack of strategic foresight, healthcare providers have to face immense challenges in surviving the financial uncertainties_caused by the ongoing pandemic. Of course, nobody really knows all of what tomorrow will bring. But there are certain elements that are obvious_particularly when it comes to the medical billing and coding industry. Because it has become one of the most rapidly evolving industries in the United States.
Payers policies, federal laws, billing guidelines and medical codes are constantly witnessing changes. It has been predicted that there are much more evolutions to come in the upcoming years. No one wants to lag behind their competitors. Therefore, actions must be taken today to get your healthcare facilities ready in time. However, in this challenging era, almost every medical practitioner tries to figure out: Is there a way that revenue leaders can plan for a financial crisis or times of uncertainty? The answer is Yes! No doubt, providers can’t foresee every potential crisis. But they can make backup plans in case any financial challenge hits their business.
However, before thinking ahead, it’s crucial for medical practitioners to analyze the current challenges. That their practices are facing in terms of medical billing and coding. Some of the top providers have revealed the following common RCM issues that almost everyone is facing now.
- Claim denials.
- The burden of prior authorization.
- Lack of valuable resources and time.
- A huge communication gap between payers and providers.
- Inefficient billing models.
- Lack of automation/technology.
One Affluent Solution!
Do the above-mentioned factors sound familiar to you? Is your medical practice struggling to get out of the financial crisis? Then don’t worry! Healthcare practitioners who have successfully overcome the current financial crisis and are ready to face any uncertainties in the future as well_find outsourcing their revenue cycle management as the best solution to cope up with the economic recession and thrive afterwards. Benefits of outsourcing medical billing services include; speciality-specific billing, dependable coverage, industry benchmarks, customized reporting, staffing, improved billing collections and reduced capital costs & administrative burden (associated with managing an in-house RCM department). The right billing partner always provides you with the financial peace of mind you deserve and puts your mind at ease. So you can focus on what really matters i.e. serve the community for a better cause. In addition to this, providers find outsourcing as the best way to prepare their health care businesses to overcome the current challenges and stay financially fit in future as well. Here’s how!
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Collect & Act On Your Data
In order to get a better idea of which areas of the revenue collections management need improvement. It is crucial to collect and dive deeply into the RCM data. The next step is data analysis. It is quite complicated and time-consuming to analyse the pile of that data. So the expert tip to deal with this issue is identifying and tracking the key performance indicators (KPIs). It’s not just enough to measure and track the KPIs until you don’t take action to eliminate the RCM inefficiencies and prevent such occurrences in the future as well.
If you are already running short of time and resources, then outsourced medical billing experts serve their purpose. They are efficient enough in analysing and benchmarking the data. They help health care providers to identify prime areas for improvement, and then implement advanced medical billing solutions to achieve improvements.
Audit Denials
As we have already discussed that the frequent claim denials have become a leading cause of significant revenue loss. It has been observed that some of the medical practices are struggling with the high rate of claim denials i.e. more than 10%. Here’s a question that arises; how can a practice keep the denial rate minimal as much as possible? In order to take action, it’s crucial to get to know the root causes that result in denials. For this purpose, you should analyse the claims backlog to identify the most common reason.
For example, it might be possible that most of your claims get denied due to coding errors or inefficient medical documentation. Once you get a complete understanding of the reason behind claim rejections, you become better able to implement proactive strategies to address the root of the problem within your revenue cycle process. You must hold the responsible staff accountable and make sure that they work diligently to prevent future claim denials.
It’s pertinent to mention here that providers cannot keep their revenue cycle optimised without the assistance of the right people_who have extensive domain expertise. Meanwhile, by joining hands with reliable billing service providers, you can get access to a large talent pool. That comprises certified medical coders, billers, accounts receivable managers and revenue leaders. They not only resolve the existing unpaid claims but also play a significant role in shifting your medical practice from claim denial management to prevention.
Focus More On Patient Collections
The ongoing pandemic has directly affected the patient’s affordability factor. Furthermore, patients’ financial responsibilities have grown due to the rising health care costs, high deductibles, copays, coinsurance and out-of-pocket costs. Due to all these factors, it has become more challenging to collect payments from patients. As the patient copays make up a major portion of a healthcare revenue cycle. Therefore, practitioners should pay special attention, when it comes to collecting payments from the consumers. So, make sure that your team members know how to effectively communicate with patients about their financial responsibility and request payment. Moreover, here are the following tips that can help you in maximizing patient collections.
- Create and deploy a written payment policy.
- Ask your patients to sign this document during the registration process.
- Provide a complete financial picture of patients’ copay and out of pocket costs before providing the services.
- Collect payments upfront.
- Prepare understandable medical bills.
- Offer flexible payment options.
Get Ready For These Trends in Future
Innovation always brings certain challenges. But with the adoption of the right strategies, you can easily overcome and embrace the change to drive better results. So, prepare your medical practice according to these trends, which is likely to engulf the entire healthcare industry in the upcoming years.
- Billing and coding for digital and telehealth services.
- The utilization of advanced technology to monitor the patients from remote locations and more importantly handling the billing processes will become the need of the hour. For example, the digital methods of patients’ scheduling, changing, cancellation of appointments, and access to the health records from any remote locations, will completely replace the manual methods. So, prepare your budget and start thinking about your staff training in this matter.
- The federal/state billing and coding regulations will change the ways one manages the revenue cycle. For instance, the implementation of the No Surprise Act and Hospital Transparency Rule is going to reshape the medical billing systems.
- Moreover, the current situation will intensify the need for more updated communication portals or applications. That bridges the gap between medical practitioners and patients.
Addressing the current and upcoming RCM challenges requires an effective action plan. But it’s also true that making impactful strategies isn’t a piece of cake. It requires a considerable amount of time and skills. Healthcare providers who are already wearing too many hats may find it overwhelming to keep a perfect balance between patient care and these non-core functions. Therefore, the trend of hiring revenue cycle management service providers has become a new normal in the United States. One of the major benefits of outsourcing medical billing services is having a strategic plan in place to stand strong against future economic crises before they hit you.
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