Medical coding and compliance programs are very different today from what they were years ago. In the past, these programs had relied upon manual processes and time-intensive reviews of code selection.
With the growing take on value-based reimbursement and healthcare consumerism, it has become vital for provider organizations to ensure their healthcare revenue cycle is operating at maximum efficiency.
The increased complexity of insurance management systems has created millions of dollars in lost revenue and forced hospitals to prioritize cost control in recent years. The revenue deficits have in part resulted from insurance claims denials and ineffective management of claims processing.
Due to a lack of resources and a shortage of patients, healthcare providers in rural communities encounter unique financial challenges compared to their urban counterparts. Along with revenue cycle management, all hospitals, regardless of size, must stay attentive to patient health and data analytics to monitor their overarching success.
Hospitals in rural communities are more prone to revenue cycle challenges, ranging from physician shortages and hospital closures to a higher degree of uninsured patients. The solutions for such complex problems are not universal to healthcare reform; rural communities are unique. The CMS Rural Health Summit has identified healthcare institutions in rural settings as the biggest opportunity for healthcare reform. By incorporating strategies tailored to the improvement of revenue cycles in rural hospitals and practices, experts aim to simultaneously improve the economy and access to care in remote settings.
The healthcare revenue cycle is multifaceted and complex, therefore causing many medical facilities and operations to overlook prime opportunities to enhance RCM. With awareness of such revenue possibilities, hospitals and other healthcare providers can maximize their profitability at every transaction.
Revenue cycle management (RCM) is crucial to a healthcare organizations financial organization and success. By utilizing RCM’s medical billing software, providers can track the entirety of the patient care process, from registration to appointment scheduling and final payments. With the new age ICD-10 and a growing level of financial responsibility, many medical employees are working…
There are more reasons to outsource your revenue cycle management today than ever before. Stringent regulations, escalating costs, and the shift to value-based reimbursement models have each helped to saddle physicians with heavy burdens. Because of their high-deductible health plans, there are more patients who are responsible for their out-of-pocket costs than there had been a decade ago. These patients are more difficult to collect from than from institutional payers. Due to the drastically reduced rate of collection from patients than from other payers, healthcare organizations are spending increasingly more time and money chasing after self-pay accounts. Practices have to step up their efforts in an effort to manage their revenue cycles in order to survive.
Is the medical billing service you use causing your practice to lose revenue? Bad debt for medical practice is mostly caused by payer nonpayment, and many patients carry a past due balance for at least 60 days. If this appears to be the root of your practice’s problems, you may need someone who can analyze why claims for payment are being denied. Perhaps over time, you have noticed patterns in the revenue cycle which are not efficient or productive, causing the decrease in your practice’s financial performance.
You might be reluctant to make changes if you do not know specifically how to pinpoint the root of the problems and what to look for in a new service provider. Start by taking a closer look at the aspects of the process that your practice can manage, such as your patient volume, capacity and what you charge patients for your services. Also, it is ideal to have a thorough understanding of internal processes such as registration, insurance verification and proper code capture for the services offered. Following is a guideline to help ensure a smooth transition to a new provider.