Did you ever wonder what would happen if your local hospital or trusted physician went out of business because they failed financially? Did you even know that was possible? Unfortunately, it’s a stark reality we must face in today’s complex healthcare environment.
According to an article published by the Healthcare Financial Management Association, between March 1 and June 30, 2020, healthcare providers lost a staggering $202 billion. Why? In part because their revenue cycle — the process of collecting out-of-pocket costs at check-in, correctly charging for services, filing claims, and receiving reimbursements from payers (primarily insurance companies) — is fraught with administrative waste and error.
The good news? Many of these costly mistakes can be prevented with the right dose of technology and data — a “prescription” that can restore the financial health of providers and sustain their well-being.
Here are five tips for achieving and maintaining a healthy revenue cycle:
1. Give patients accurate estimates before they receive care
In healthcare, making prices transparent is the law because patients should be able to shop around for their care, much like they would any other purchase. But many providers lag behind in meeting this requirement, leaving patients in the dark.
To make pricing accessible, providers should use technology that creates estimates that are at least 90 percent accurate and can be generated online at the patient’s convenience. Patients who know what to expect are more likely to pay upfront for services, preventing providers from incurring costly collections processes and bad debt.
2. Charge correctly for patient care
That sounds easy, but it’s quite complex. Prices and industry regulations are constantly changing, making it difficult to stay current. Providers need a central source of truth, a cloud-based technology platform called a charge description master that provides benchmark pricing for hundreds of thousands of supplies, medications, and services. And they need auditing technology to make sure they capture every charge they are owed. These tools ensure pricing is consistent and compliant with regulations.
3. Get fast, accurate reimbursements
For this to happen, providers need to: 1. file accurate, complete and properly formatted claims, 2. continuously scrutinize contracts they have with payors, and 3. efficiently collect what is owed. The right technology takes care of it all.
Claims management tools can deliver a “claims acceptance rate” of nearly 99 percent. Contract management tools accurately forecast, calculate and capture the total revenue owed from complex contracts. Collections management tools analyze a provider’s accounts receivable workflow, determine the causes of delays, correct errors, and collect payments.
4. Leverage data and “bots” to improve efficiency
Providers are typically blind to the meaning of all the datasets in their various billing systems. Data analytics tools integrate and map this data into one holistic view, giving providers more insights into their operations, identifying performance improvement opportunities, and informing their decision-making. In addition, providers can use software robots (bots) to perform repetitive, manual tasks, freeing up staff to focus on high-value work and increasing productivity.
5. Tap into knowledge sources to stay current
With all the complexity and change, providers need a cloud-based platform that continually delivers updated coding, billing and regulatory information to reduce waste and errors throughout the revenue cycle. To maintain and grow staff expertise, they should consider offering employees an online revenue cycle education program that includes certifications and cross-training to increase engagement and retention, as well as online and easily accessible billing and coding references.
With the financial health of our hospitals and physician practices so critical to maintaining the health of our nation, providers would be wise to get an end-to-end revenue cycle check-up and follow the recommendations of healthcare technology experts.