Looking to Improve Your Revenue Cycle Management?
The growing challenge of rising provider costs, a volatile healthcare market, and patient debt may seem impossible, but that is precisely why revenue cycle management is so important. Revenue cycle management is dynamically evolving under a growing value-based approach to care in an age of digital innovation. As a result, providers, from single-doctor family practices to large hospital systems, quickly have to learn to adapt.

How Does Value-Based Care Affect Revenue Cycle Management?
As the healthcare industry shifts in part to a more value-based approach to care versus a fee-based approach, revenue cycle management is remolding itself again. What does this mean for providers?

Smart Tips for Improving Revenue Cycle Management
Improving revenue cycle management might seem like a lofty, costly, and time-consuming goal. However, it’s “the little things” which can add up to the most significant impact.

Smart tips for improving Revenue Cycle Management include:

 1. Enhance Pre-Admission Contact

Want to boost cash flow fast? Going the extra mile before a patient’s admission may do just that. Make contact before an appointment or elective procedure with a simple phone call or an email directing patients to printable forms they need to fill out, confirm how and when payment is processed, and explain what to expect at the appointment/procedure.

Connecting before admission also speeds up registration time the day of admission and allows patients to ask any questions or voice any concerns they may have. This, in turn, establishes a solid and friendly foundation from which patient loyalty will grow. Therefore, your team in charge of intake and registration should feel inclined to achieve as much as possible in this beneficial window before patient arrival, even going so far as to verify contact information (including email address) and even potentially to take payment over the phone.

Your front-line staff who handle pre-admission communication and registration workflows are a vital point of contact for understanding where roadblocks in the process lie. Regularly survey and conduct dialogues with this staff, especially as data insights reveal trending mistakes or tasks that take too much time. In addition, you may be surprised to learn that simple office upgrades like standing desks, new headsets, or back support for office staff chairs can significantly impact the front-line experience and team performance. 

 2. Use Software Solutions to Streamline RCM

Digital solutions through revenue cycle management software and online patient portals are necessary for streamlining patient communication and payments. Cloud-based RCM software offers medical providers the unique ability to aggregate claims filing, invoicing and payment transactions, appointment scheduling, and patient data (among other things) all in one convenient place.

Insights into patient trends, i.e., rates of visits, occurrences of chronic illness, payment rates, etc., can help your organization make data-based decisions regarding updating technologies and services. And housing all accounts receivable information in one central place can make the patient intake, billing, and payment processes more efficient.

Patient portals like Phreesia, which allow patients to check-in or reschedule appointments, access health records, resolve outstanding balances, request refills, and message doctors, also empower patients to take a more prominent role in their health and wellness. Of course, the value of healthcare comes across not just through the treatment and medicine which helps a patient recover from illness. Still, in the steps, a medical provider takes to help a patient prioritize transparency and prevent disease. Interactive online tools that give patients more control over their health management reflect well on both the goals of your office as well as your modern embrace of technology.

3. Appoint a Dedicated Care Coordinator

Under a value-based care net, increasing patient volume and ordering more tests and treatments no longer guarantees more payout from insurance companies. Instead, government programs and insurers are looking further past the quantity of a provider’s care to the quality and efficacy of their care.

Understanding the transition in policy by which payouts and reimbursements will be measured by the quality of care as well as the efficiency of the organization will require the involvement of a dedicated care coordinator. A care coordinator can stay updated on legislation and policy changes, update your organization’s financial policy, and work with providers and patients to optimize care under the new value-based model.

Positive medical outcomes will be the product of more vital patient/provider collaboration. Care coordinators can serve as those liaisons between both parties, helping clinicians better understand patient concerns and health hurdles and motivating patients to claim a more significant role in their treatment and wellbeing.

Care coordinators can also organize health and wellness clinics that exist outside of the day-to-day appointments and procedures and which do in fact, optimize the quality of care patients receive. Billing, coding, and collecting will no longer be the only force by which revenue cycles churn. Care coordinators can play an essential role in ensuring health systems and providers recognize care quality goals and formulate programs that provide the highest payouts, boosting patient loyalty and health outcomes.

4. Improve the Patient Financial Experience

The coverage landscape has changed so drastically in the past two decades to a point where some healthcare organizations which were once receiving only 10% of all payments from patients (the rest paid out by health insurance companies and the government) now rely on patients to make up over 30% of all charges.

A volatile marketplace combined with fluctuating legislation has driven many patients to buy into high-deductible plans with low premiums. These types of insurance plans are more affordable on a month-to-month basis for patients but often leave patients footing the bill for the entirety of all their appointments, prescriptions, or procedures. In addition, a report from the Advisory Board found that the higher a patient’s deductible, the less likely they were able to pay for their care at the time of service.

Patient adherence to payment requirements can vary from organization to organization and often are not met because of reasons including:

• Patient inability to pay the amount required    
• Patients did not know they owed money.                
• The patient does not have needed payment method (i.e., your office requires a check or cash, and they only have a credit card)
• The patient disputes the charge.
• The patient doesn’t understand the bill.
• The patient missed the bill in their mail.
• Filing errors sent the bill to the wrong place.

Providers can take small, manageable steps to improve the rate of patient payment, including verifying accurate contact and mailing information before admission, offering multiple methods of payment (i.e., credit or debit, payment plans, online portal, etc.), and collecting copayments before treatment.

Providers also need to recognize shifts in patient expectations and act accordingly. For example, an older patient might be used to getting a bill in the mail, while younger adults in their 20s and 30s might rely more on email and text messages for payment and appointment communication.

5. Measure, Measure, Measure

Simply knowing your organization is behind on collecting payments or is making too many errors when filing claims isn’t enough. Successful revenue cycle management relies on measuring key rates and statistics and setting common goals to measure the efficacy of workflow changes and updates to existing protocols. 

Collection rates, for example, paint a picture of the percentage of patient payments that are successfully captured during a billing cycle. Medical providers want those rates above 85% minimum and even closer to 95 or 100%. While the hard truth is that some patients will never resolve their balance, it’s critical to learn how many are paying and what steps can be taken to increase that number.

Advanced measuring of critical metrics and benchmarks can also highlight recurring discrepancies in claims filing, denials, and billing. Keener oversight might reveal irregularities in specific payor denials, helping to pinpoint potential issues worthy of contract negotiation.

Other vital statistics worth monitoring are how many claims are denied and for what reasons (i.e., typo, coding error, missing information), the average number of days it takes patients to settle a bill, and how often patients miss appointments when they are reminded via phone call versus email or text.

While consistently the topic of political debate, the continued evolution of the healthcare system in America will largely be shaped by the patients themselves and those medical providers who treat them. On the patient side, you have growing rates of obesity, heart disease, diabetes, Alzheimer’s, and other chronic conditions which require ongoing medical care. Combined with an aging populace of Baby Boomers who will all age into Medicare eligibility by 2030, providers have an explosive reason to optimize value-based payouts.

How healthcare organizations adapt to both value-based payout models and mounting demand for digital solutions will forge the future of revenue cycle management as the country knows it.