How Hospitals Should Rethink Their Revenue Cycle to Prepare for Value-Based Care, Patient Experience
Marcy Marquis, CRCP-P
maxRTE Client Services Manager
Healthcare revenue cycle executives are drowning in operational issues, increasingly demanding consumer expectations, new care and reimbursement models, and declining margins. Revenue cycle directors say they need technology from their EHR, which is tied to their billing system, to modernize their revenue cycle and wring every cent out of its revenue.
Fill the gap caused by missing analytics and metrics
Revenue cycle directors want to improve clinical workflow, manage and improve operations, and understand their performance. But according to “Healthcare Finance,” Chuck Alsdurf, director of Healthcare Finance Policy for the Healthcare Financial Management, said they don’t have access to advanced metrics and analytics for monitoring and managing revenue cycle performance in the EHR. Instead, they must look to tools outside of the EHR.
“There’s a dichotomy between the new technology applied to revenue cycle,” says Alsdurf, “and they’re still using the fax machine.”
Make it easy for patients
Beyond adopting technology absent in their EHR, revenue cycle performance is challenged by the fallout from higher deductibles consumers are choosing to keep their health insurance costs affordable. As a result, it’s more difficult to collect larger balances. According to Michael Rawdan, senior director of the revenue cycle department at St. Luke’s in Idaho, patient obligations have increased 29.4 percent since 2015.
Of the three revenue cycle components—registration on the front-end, coding in mid-cycle, and back-end billing—there’s been greater emphasis on the front-end to get payments up-front or for a digital solution to set up periodic payments. It’s stands to reason.
The front end greatly influences the rest of the cycle. When patients know and understand what services their insurance will cover and what their owed balance will be, they can buy into an automated payment plan. Furthermore, when the hospital has the technology capable of discovering insurance that the patient wasn’t aware they had, patients often owe smaller balances. This method of insurance discovery also accelerates insurance payments by helping prevent misfires in claim submissions.
In addition, patients expect to pay their bills and manage their accounts online through their smartphones and computers. This evolution is making it imperative that hospitals and physician offices make it easy to register by tablet, pay electronically, and get payment in advance for elective procedures.
Revenue cycle departments need to offer automatic enrollment in payment plans and financial counseling for patients who don’t know that they qualify for government programs, Alsdurf said.
Other hurdles facing revenue cycle directors include a significant increase in claim denials, from government to commercial plans, Alsdurf said, denials are due to reasons surrounding medical necessity and the technical process. As a result, says Alsdurf,
“What’s happening is there is more discussion on improving the processes on the front-end and reducing unnecessary denials and collaborating with the health plans on ways to reduce these issues, because it costs both sides money.”
The solution lies in finding software vendors who can assist revenue cycle managers in limiting collection costs associated with self-pay receivables and get paid sooner. This will positively impact a healthcare organization’s bottom line, and reduce the amount of time individuals in the office have to manually work on a patient account.
maxRTE has been helping healthcare providers shorten the revenue cycle for more than 20 years. With maxRTE, just one click validates plan-specific benefit data such as patient coverage effective dates, co-pays and deductible information. Visit maxrte.com for your free web demo.