Healthcare revenue cycle challenge is there at every stage of the patient journey. It starts with the patient access and extends till the claims, billing, payments and collections. However, the digital tools and analytics can assist the service providers to handle the top healthcare revenue cycle challenges. A variety of aspects impact the healthcare revenue cycle management such the complexity of reimbursement structure and billing. The complexities to add to the RCM challenge are technology, regulations, people, changing contractual obligations, payer policies, processes, claim and billing etc. RCM issues can cause revenue loss when not addressed properly. Digital tools, data and analytics, automation can help the service providers to deal with complexity and adjust with the changing patient needs. Here are the top challenges revenue cycle and how providers deal with them

Problems with patient access

Automating streamlines the process. Offering patient intake software that can be accessed online or via a mobile device provides the flexible and familiar digital experience they expect in today’s world.

Consumers who are accustomed to use mobile apps and online services to purchase and do their banking related works and make it seamless for the digital experiences when they are selecting a service provider. It includes scheduling appointments and managing pre-appointment activities such as insurance verification and registration. 77% of the patients who were not using the digital tools for healthcare will be highly interested in switching to a service provider that offer a patient portal, according to reports. The patient engagement gets a huge makeover when the automated tools create the digital front door.

The RCM solutions with precise estimates and convenient payment options help the service providers to improve the patient journey and enhance the registration accuracy. The manual processes need more employees up-front, human-made errors can bring claim denials or billing issues in the later stages of the cycle.

Poor collections recovery rate

Patients are having a harder time making ends meet as a result of high deductible health plans that require them to shoulder a greater portion of the expense of their medical care. Larger costs can mean more uncertainty, more concerns about insurance coverage, and more need for financing solutions. As greater attention is placed on the patient as a payer, providers require effective collections tactics to increase revenue and decrease bad debt write-offs. Patients can better understand their expected expenses, insurance coverage, and payment alternatives with the use of a patient-centered payments strategy. Providers will need to provide the following assistance to patients in order to help them effectively navigate the financial process and this challenge with the healthcare revenue cycle:

  • Clear, accurate estimates that show patients how much they’ll owe up-front
  • Payment options that include multiple payment methods, including cards, Apple Pay, and e-checks
  • Navigating payment plans to manage large balances
  • A process that encourages payment before service or at the point of service to reduce collections down the line

When providers have to collect, digital tools and analytics can help optimize the collections process by prioritizing accounts that are most likely to pay, automating billing and messaging workflows, and even tracking the effectiveness of outside collections agencies.

Billing errors

Workflow is hampered by claim denials, which put staff members in a cycle of submitting, denying, correcting, and delaying claims. This disrupts the flow of revenue. Reimbursement is typically delayed by 16 days for each refused claim. Even worse, claim denials are on the rise: according to 69% of healthcare executives surveyed by MGMA Stat, denials rose at their institutions in 2021. Billing errors and A/R days can be decreased by replacing manual operations with automated workflows. Before claims are submitted, integrated claims management software checks them for inaccuracies in coding, minimizing claims denials and lowering the time between billing and payment.

Underpayments in payer contracts

Your revenue cycle management may become more stressful and volatile as a result of missed payments and underpayments. Complications with payer contracts are frequently the cause of these issues. Often, your book of business is better known by your payers than by you. You must be able to rapidly and effectively sort through a lot of information when negotiating contracts so that you may be well-prepared. One of the services we offer is contract analysis, which enables suppliers to assess contract terms in actual monetary terms. Healthcare Contract Management enables providers to track incorrect payments and hold providers liable for them for contracts that are still in effect.

Changes in healthcare regulatory and compliance standards

The healthcare industry constantly faces new rules. But maintaining a healthy revenue cycle in healthcare is one of the largest issues that providers face. Claim denials, payment delays, and administrative and invoicing backlogs can result from failing to keep up with the always changing compliance landscape. Making regulatory compliance a regular aspect of your business operations may be made simpler with the help of Healthcare Regulatory Solutions, which includes tools for giving transparent, patient-friendly estimates. Providers can access a free No Surprises Act (NSA) Payer Alerts Portal to stay informed about the implementation of new NSA requirements.

Lack of data-driven metrics and insights

Obtaining efficacy in healthcare revenue cycle management means use of analytics for providing a big-image view of what is happening in the organization. This is not always the default perspective in a busy healthcare practice or a hospital. Though, fixing multiple claims individually is not going to give you the required efficiency. You have to acknowledge the trends to find the biggest scopes for improving the results. The comprehensive data and analytics are the key service providers that want to target and address the trouble areas. Here the new solution can create a single view that is required for diagnosing the issues such as slow down claims, billing and payment. Healthcare revenue cycle management analytics integrate with the client data with the non-native electronic data and gives room for more improvement. By bringing the right data, the service providers can optimize the patient access productivity, billing efficacy, reimbursements and payer performance.