Healthcare RCM: Gain Robust Actionable Insight & Make Better Business Decisions

Business Insights & Healthcare RCM

Knowledge is power. We all grew up by listening and reading this cliche. Believe it or not, it truly works, particularly for businesses to thrive in this highly competitive market. The same is true for the healthcare businesses. In this modern era, the use of analytics is no longer limited to big organizations with abundant financial resources. Now the scenario has been changed. It’s now widespread & almost every business, including the healthcare industry, using analytics in some capacity.

Due to the immense benefits, the trend of business analytics has become a new norm in the medical industry. Analytics helps healthcare professionals to make better business decisions. It enables them to take initiatives to improve the revenue cycle management & overall operations of their healthcare facility. Before further discussions, it’s pertinent to mention here that business insight combines data and analysis to understand a particular situation. On the other hand, actionable insight means making and implementing strategies to fix the problematic areas & gain a competitive edge.

There are four tiers in an actionable insights pyramid.

Data: It includes raw, unrefined facts that can be either qualitative or qualitative.
Information: It’s the next step in which the raw data is being processed and given context.
Insights: Insights are created when you carefully analyze information and become able to drive results.
Actionable Insights: After having a complete understanding of the particular problem and solution, you take action to improve the particular area.

Business Insights and Healthcare RCM

Business insight can be a game-changer in healthcare revenue cycle management. It enables medical practitioners to implement advanced solutions to eliminate the inefficiencies in revenue collections management. And keep your business financially fit as well as afloat.

The insights gained also play a crucial role in streamlining workflows, managing the issues that hold up reimbursements & staff education. Furthermore, recent innovations in analytics technology provide real-time access to the practice data. As a result, physicians can establish and track key performance indicators to optimize the medical billing services, reduce capital costs and streamline cash flow. Which can help you in the following ways:

1. Uncover ways to Reduce Expenses
Revenue cycle analytics developed at the departmental levels help medical practitioners to find wasteful spending in some cases. For example, evaluating the capital costs of each and every department can help you to make a better decision. That on what points you can cut costs without affecting productivity or performance. Moreover, you can identify cost-avoidance opportunities.

2. Identify & Eliminate Billing Errors
The majority of healthcare providers lose a significant amount of revenue just because of the high rate of claims denials. A claim gets rejected o denied when insurance companies send it back without processing due to certain reasons such as:

  • Missing/incomplete patients’ information such as; name, gender, age, date of birth, mailing address, phone number, insurance ID etc.
  • Lack of prior authorization/invalid insurance information.
  • Incorrect transformation of patients’ diagnosis, treatments, equipment and medical services into standard medical codes.
  • Upcoding, undercoding, unbundling, incorrect modifiers etc.
  • Duplicate billing.
  • Failure to keep up with the latest regulations established by the payers or regulatory authorities.
  • Late filing of claims.

Once you get to know the root causes that result in claim denials. You can implement proactive strategies to set your medical billing system free from errors. That can help you to get your revenue collections management back on the right track and collect maximum payments. For instance, if you find that most of your claims are being denied due to negligence in performing front desk staff i.e. patients scheduling or registration.

You can take preventive measures like, implementation of the EHR solutions to automate the administrative workflow. Or hire well-experienced registration staff to prevent the potential errors. When the right medical billing strategies are being adopted, healthcare providers can witness optimized revenue collection and cash reserves.

3. Higher Co-pays/Deductibles
One can’t deny the fact that a major portion of the cash flow is highly dependent on co-pays and deductibles. If you are falling behind on your revenue goals and witness fewer collections than expectations. Then RCM analytics enable physicians to get to know the reasons that hold patients back from fulfilling their financial responsibilities.

These metrics can uncover the areas of improvement and suggest several methods to improve the pre-service collections processes. Such as; educating registration staff on how can they collect the co-pays and deductibles up front. More importantly, they can have positive financial convection with patients for improved results.

For example, if business analytics indicate that your payment methods aren’t flexible enough or your staff isn’t capable of educating the patients about your payment policies etc. Then you can take practical measures to fix these loopholes and enhance your financial well-being.

4. Keep Up With Industry Trends
The Healthcare industry witnessing constant changes in terms of federal/state laws, payers’ policies, medical billing and coding guidelines. However, failure to keep pace with the ever-evolving medical industry not only negatively impacts your RCM process. But the overall success of your healthcare practice.

Meanwhile, reliable business insights identify the area where you are lagging behind. And enable you to stay at the top of the healthcare reforms and ahead of the competitors.

5. Puts Practices in a Competitive Position
The analysis of previous data as well as the real-time data, also helps healthcare providers to gain a competitive edge. In this way, they can stay aware of the latest trends in the healthcare market. As advanced billing tools or other trends that directly or indirectly impact the RCM process.

Hence, having a complete understanding of the areas that need improvements. And solutions for all the problems related to your finances issues can help you to take your service standards to the highest level. Do you want to stay informed about the latest trends in the healthcare industry? Then stay in touch with the Medical Billing Benefits and get the current information about the latest happening in the medical industry.

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