The meaning of the term healthcare revenue cycle solutions cannot be contained in one or two sentences. It is much more than a team of professionals and an advanced software functionality. These two comprise the core components for sure, but it also includes some essential versatility, strategizing and implementation nuances. The end goal is nothing but process improvement and a completely transformed revenue cycle for the provider’s practice.
A gist on the strategies implied
One cannot conclude the strategies in a few words but here is a gist of the areas of focus for the proposed changes
- Enhancing front office efficiency
- Better front -end payment collections
- Revised coding practices
- Strategies to reduce leakage of revenue
- Definite approaches to bring down claim denials
- Analysing the root causes of noncompliance
- Expanding the payer network with better credentialing practices
Illustration on optimizing the workflow
Let us try to understand the working of healthcare revenue cycle solutions by taking up the situation at a so-called mental health practice. The practice was going through a tough spot financially before taking up a healthcare revenue consultation.
At that point, the organization was suffering from the following snags;
- The practice was following age old treatment polices which never got updated on the course of time. Healthcare staff were absolutely unaware of the new updates on managed care programs of State as well as commercial payers.
- With no proper guidelines set regarding treatment charges, the practice was constantly struggling to collect patient liabilities. There was no definite system to educate the patient on payment breakdowns and coverage options. This often led to unwanted confrontations regarding payment and patients left the practice unhappy most of the time.
- The billing staff were not aware of the latest billing criteria put forward by the insurance payers. Moreover, there was an existing confusion regarding payment guidelines of each payer. With major mix-ups happening all the time, rate of claim denials was up and rising.
- The healthcare revenue consultants conducted an initial audit which found quite a few critical errors and risk factors with respect to the existing coding process. The coding staff were inept at following latest coding criterions and use of suitable code modifiers. This added up to claim denials furthermore. Some of the errors were serious enough to put the practice in major legal risks.
- The amount of ageing account receivables was quite baffling in the first place. Neither were they properly accounted or looked into for prompt payment receival. Practice was facing serious revenue loss due to the enormous amount of money yet to receive from these account receivables.
- Efforts exerted for effective communication with patients and treatment follow-up were practically non-existent. It was solely managed by the individual providers who neither had the time nor convenience to answer to patient -queries. As a result, rating and reviews on the practice was quite poor and degraded.
Critical steps taken for damage control
- One of the leading healthcare revenue cycle solutions were hired to look in to the problems at hand. Subsequently, they framed a plan of action for immediate damage control as well as prolonged process improvement. Following are the steps for resulting outcomes;
- Conducted thorough chart audits and billing process audits based on individual providers, departments, services and specific time spans. The results of the audit were share with the healthcare providers and administrative staff subsequently. This turned out to be a true eye opener for all flaws in the practice management.
- All the existing claims under processing were accounts and list out categorizing them on reasons for ageing. The expert team implemented healthcare revenue cycle solutions for analysing the core reasons. Further, they took all the necessary actions to speed up payment collection.
- Team approached all past and present denials faced by the practice and planned suitable strategies to work them out. They contacted the insurance companies to obtain clarity on the reason for denial. Some were demographical errors, whereas some claims deemed noncompliant to the revised guidelines. With the back-up of legal appeal process, they were able to renegotiate for reimbursement.
- Another part of the strategy was to work on provider credentialing. The healthcare revenue cycle solutions include additional services like provider enrolment and contract negotiation. The credentialling team comes equipped with a well populated list of local insurance payers. And they enrolled the provider with maximum payer networks. This helps practice get payment from maximum number of payers.
- The most important change brought about was the transition of revenue cycle management to a completely digitalized platform. This started with installing a state-of-the-art practice management software, billing software and front office software. The professional team worked on migrating the entire process over to the new platform and trained the staff on how to work on it. This helped rendering the workflow smooth and flawless.
- Last but not the least, the healthcare revenue cycle solutions brought in a new system of patient engagement at the practice. With online patient portals, mobile applications and call centre services, patient was made a part of the process. This in turn helped improving provider- patient relationship, positive reviews and reputation of the clinic. This proved to be a win-win for either party.