Medical practices are experiencing the most upheavals of RCM costs in 2021. The latest economical challenges and recent regulations have thrown up immediate requirements for efficient revenue cycle management. Practitioners across the United States are solely focused on enhancing volume, growth, and revenue.
However, medical practices have wasted hundreds of billions of dollars on service duplication, variation, supply chain inefficiencies, and suboptimal labor management. This has directed the healthcare industry to face cost problems and a financial quandary.
Therefore, healthcare systems need to change their business models to pay attention to costs for addressing these margin challenges.
Moreover, healthcare practices need to address the principal causes of high costs and implement creative smart solutions to prosper value-based care and improve their financial health.
Medical facilities are bearing more and more of the healthcare cost burden with high-deductible plans. Let’s explore and take a look at the major challenges for RCM in 2021 and some ways to get it under your control.
Reports Determine RCM Challenges
The Center of connected medicine stated that revenue cycle management is the area that requires the greatest innovation among all the other things.
According to the ‘’Top of Mind’’ report, in 2021 there were up-to 75% of respondents who want to see innovation in RCM. Observations that were notable;
- For price transparency, more regulatory changes were needed.
- Coding and billing can benefit greatly from revenue cycle management.
- Telehealth plays a crucial role in impacting the revenue stream.
- Technology can help you make efficient decisions and track the revenue cycle.
- Automation, predictive analytics are seen as significant components to boost RCM efficiency.
- Proactive focus on key front-end RCM steps which include patient registration, scheduling, prior authorization, insurance eligibility, and upfront patient collections.
- Back-end RCM processes include medical billing, claims management, and final patient financial responsibility collection.
The report identifies successful practices were those who will successfully blend and leverage innovative tools. However, it is seamlessly important for streamlining medical billing services and reducing revenue leakage.
Moreover, better integrating virtual patient visits into a care pathway reduces dropped handoffs and also leads to improved care.
Potential to Boost Revenue and the Pricing Concerns
If you outsource billing your practice might be correct to wonder about the costs. Which can lead you to fear of the unknown. But it is trivial to evaluate costs and make comparisons.
It is typically cheaper to pay a third party for managing your billing than having an internal billing department. With in-house billing, you are not paying only the payrolls_ but their taxes, healthcare, office costs, and training.
Work is less accurate when done manually as compared to experts taking on the task. Therefore, a business switching to an external vendor from an internal billing department can boost their revenue on an average by $200,500.
Costs of Time and Struggle
Healthcare practitioners are frequently busy in handling the hefty tasks of medical billing. Therefore, the major reason practitioners want to outsource their revenue cycle management is that_ they want to put their focus on what they love to do, providing quality care services to patients. This can center their attention on satisfying patients and make them free of complex financial tasks.
I have highlighted the 8 main billing responsibilities that need your complete attention if neglected can lead to the increased errors and delayed reimbursements.
8 Tasks of Billing
- Keeping a record of patient demographics.
- Insurance verification of patients.
- Submission of clean medical claims.
- Identify the charge entry.
- Denial management.
- Follow-up when necessary.
- Finishing financial reporting.
- Awaiting payment to post.
Each of the procedures associated with the healthcare RCM process takes a lot of time. The administrative personnels require to keep track of unpaid patient bills which require a lot of time. Such tasks may hinder the growth of your practice as they are taxing and time-consuming.
Utilize Technology to Control Costs:
Healthcare providers tend to be driven by competition and data. They are doing everything in their power to end up at the top of the list. Show them data with quality outcomes that compares their performance to their competitors. Advanced technology could be a cost-effective tactic for getting this significant stakeholder group motivated towards controlling costs to drive maximum profits.
Innovative tools provide better practices to optimize revenue streams and improve bottom line. It provides complete revenue integrity by documenting a medical bill, justifying it, and collecting it appropriately.
Consequently, innovation and automation allow you to document the claim accurately and receive complete reimbursements. As AHIMA (American Health Information Management Association) states, ‘’ Successful CDI (Clinical Documentation Improvement) programs direct the correct representation of clinic status of a patient that is converted into the alphanumeric codes later on. Coded data is then converted into clinician report cards, quality reporting, public health data, reimbursement, and disease tracking and trending.”
Outsourcing Improves RCM Efficiency
A recent survey of Revenue Cycle Intelligence states that_ providers who are facing current economic crisis could take a financially fit solution like outsourcing to medical billing agencies.
Outsourcing helps you shift your entire focus to patient care and cut costs. RCM is complex though a critical process so practices struggle to maintain proficiency. Healthcare providers and hospitals implement technologies, hire additional staff, and workflow overhauls, etc, to enhance revenue and business efficiency.
However, this can significantly maximize costs while these strategies may improve revenue and take away resources from patient care. The survey states that outsourcing revenue cycle management has proved to be a good financial investment. It helps you implement strategies that help you boost collection and capture higher revenue.
Medical professionals need to understand the capabilities of the billing agency. Billing experts communicate with them by scheduling regular meeting to track the practice’s progress and reap the following advantages;
- Stability and accountability.
- Optimized performance while lowering overall cost structure.
- Access to advanced, consistent revenue cycle technology.
- Access to centralized pools of talent.
- Cultural fit, with aligned goals and shared values.
- Ability to scale operations.
With a trusted medical billing company, healthcare providers can ease administrative burdens, reduce costs, and maximize reimbursement_ as they focus on patient well-being and care.
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