The Healthcare Revenue Cycle: How to Optimize Performance

In the modern healthcare landscape, revenue cycle management remains elusive, as new rules and reforms have caused the sector to develop and left many hospitals trying to maintain revenue in a value-based care reimbursement model.

Today’s digital platforms may help providers, payers, and consumers connect and engage more efficiently, resulting in a more long-lasting hospital revenue cycle management plan. Revenue cycle managers should concentrate on a few key areas to ensure that their medical facility’s reimbursement is optimum. Here we will discuss how to optimize performance.

1. Reduce Denials

Claim denials cost each healthcare provider an average of $5 million per year in the revenue cycle process. Using an analytics tool to integrate data from many sources to determine the causes of denials, organizations can recoup part of this expense. Health systems can use this information to develop denial prevention programs and procedures, as well as procedures for recovering denials.

2. Increase Collections with Propensity-to-Pay Insight

Self-pay accounts are currently the leading source of bad debt for hospitals and health systems since patients are accountable for a growing portion of their healthcare spending. Bad debt costs the healthcare industry more than $55 billion each year. To avoid bad debt, health organizations need strategy-driven patient collection processes—in other words, a credible propensity-to-pay predictive model.

3. Fix the incomplete and inaccurate clinical documentation

Clinical documentation has a tangible impact on the revenue cycle, making it more than just a necessary part of the healthcare system. Medical billing is influenced by DRG assignments and medical coding, which, if assigned incorrectly, can result in refused claims or improper reimbursements. It’s time to face the facts: how detailed is your physician’s documentation?

An effective CDI program requires close collaboration between CDI specialists (CDIS), medical coders, and physicians. The CDI specialist examines all clinical documentation and consults with physicians to identify potentially missed clinical indicators or documents lacking in specificity, which, if identified early, can result in more accurate medical coding, higher levels of care and Case Mix Index (CMI), better quality reporting, and appropriate reimbursement.

4. Verify Benefits and Eligibility During Patient Visits

The verification of patient benefits and eligibility is an important stage in the billing process. While this procedure is time-consuming, a professional medical billing and credentialing service can assist in determining patients’ payment obligations and ensures that providers get paid. You can speed up the verification process by using technology that allows you to confirm benefits and eligibility before and during patient visits, before submitting a claim. Choose a revenue cycle management solution that links to all of your available payers and gives information on aspects like effective coverage dates, covered procedures, co-pays, and deductibles for a more comprehensive view of your patients’ benefits to get the most advantages.

5. Online patient payment options

Patients can use online patient payment methods to make their payments quickly and easily. The patient is on the search for more options, such as online payment methods that allow them to pay quickly. It is critical to assist patients in gaining access to simple and quick payment solutions to improve the revenue cycle and keep it healthy.

Using innovative integrated payment systems improves the patient experience and retention while also increasing the revenue cycle for the company.