The income cycle is an essential element in the administrative management of any business. In health care, as in all industries, there are steps that can and should be taken to ensure a sustainable and profitable business model. To identify the right options for improving a revenue cycle, healthcare providers must first examine current challenges, be they regulatory or financial.
There is no doubt that the environment in which healthcare providers operate today is complex and evolving. The introduction of new regulatory requirements and the increase in the number of self-pay patients and highly deductible health plans present new complications to revenue cycle management (RCM). With the level of repayment declining and days of outstanding service increasing, effective cash flow is stalling. Additionally, the trend toward pay-for-performance reimbursement models makes it clearer that revenue cycle management needs to adapt to changes on multiple fronts.
Financial and regulatory challenges
Consumerism is on the rise as employees work to contain health care costs, putting more pressure on billing platforms and rising billing costs. Financial pressures on health care organizations will increase as consumers are constantly forced to tolerate greater financial responsibility for care. Therefore, health care providers must seek new ways to adapt to these changes and minimize adverse impacts on the flow of money.
Increased regulations are leading the healthcare industry to need much more documentation to accompany every claim. This presents obstacles in the production, acceptance and approval of claims. The additional documentation also creates a break in the revenue cycle and, together with regulatory mandates such as the industry transition to ICD-10 codes scheduled for October 1, 2014, is leading to the development of revenue management systems.
Use of revenue cycle management solutions
It is imperative to implement improvements in technologies and processes that lead to maximum success in an industry beset by such rapid change. There are a variety of solutions that lead to business efficiency and offer tangible benefits such as outsourcing billing functions in order to avoid the high cost of on-site billing. The key to achieving solid revenue cycle is to keep denial rates low and collection rates consistently high. The question then is, what is the best way to achieve this?
While outsourcing individual accounts receivable tasks can be beneficial, a more holistic approach to revenue cycle management better addresses the financial and regulatory pressures that providers are experiencing by ensuring comprehensive automation of handling of receivables. claims in a timely manner. The latest tools for healthcare revenue cycles, such as remittance processing solutions, are designed to maximize revenue capture and restructure the billing and collection process with electronic claims management. , direct entry of Medicare claims, automatic secondary billing.
Benefits of process automation
Technologies for accounts receivable, such as Regions’ healthcare remittance processing solution, offer automated processes that ensure accuracy and security while reducing response times and improving productivity. Submitting claims, posting remittances, and hand searching are time consuming tasks, not to mention how expensive and inaccurate they can be. Admission cycle solutions can automatically capture EOB information and deliver publication in ANSI 835 format or formats accepted by your patient management system without manual intervention. Attachments and inquiries for claims, remittances, and statements are more automated, reducing effort, errors, and unnecessary expense.
This solution also offers opportunities to reduce the cost of collection, manual document processing, and paper storage costs. Suppliers noticed a reduction in DSO and invoice cancellation. Also, there is no need to purchase fixed infrastructure such as scanning equipment or associated service contracts. Best of all, remittance processing solutions inherently protect health information and are HIPAA compliant.
Comprehensive remittance processing solutions are managed via online requests through healthcare industry-specific tools such as the web-based archive for all remittance and payment information. Most online portals also integrate exception processing into the electronic flow by comparing and publishing articles as no-complaint or no-tolerance articles. This saves staff a lot of time. Plus, it enhances traditional Lockbox processing by using a unique daily deposit box number and claims feature that are posted automatically. Lockbox information.
All types of health care providers face the same financial and regulatory pressures. Revenue cycle management tools offer information insight and money flow transparency, allowing your organization to process and control claims throughout the entire billing cycle. Improving process efficiency through electronic automation can reduce costs and improve profitability by eliminating manual tasks and restructuring multiple processes.