Financial managers of healthcare organizations are tasked with ensuring that their organizations receive payment for the healthcare services that have been provided. This is can be a difficult responsibility when increasingly higher operating costs and lower rates of reimbursement are taken into account. It can be further complicated by the low profit margins and slow collections caused by a revenue cycle that has inefficient processes.
In order to more effective, the various processes of the healthcare revenue cycle cannot simply focus on billing and collections. A revenue cycle that is managed well is exemplified by streamlined processes that produce timely payments for services rendered and a reduction in redundant administrative duties. Accurate data, and the proper analysis of that data, is essential to achieving these efficient processes and for the medical manager to make informed decisions regarding revenue cycle processes used.
Starting with the initial moment of patient contact, the collection of accurate data has an impact on a healthcare organization’s financial performance. Data-driven revenue cycle management will produce results such as improved revenue collection processes and an increased cash flow, both of which is necessary for the enhanced delivery of health services and the increase in patient satisfaction.
[Infographic] How to improve collections from patients
Using Data to Improve Processes at Each Stage of the Revenue Cycle Front-End Processes
The key to using a data-driven revenue cycle management to improve processes is to obtain accurate data, especially during the initial contact with a patient. Accurate information gathered for front-end processes, such as the registration of the patient, confirmation of insurance eligibility, proper scheduling, verification of benefits and the determination of medical necessity, is vital to clean insurance claims. Having the correct data at this stage can ensure that the claims can be filed correctly the very first time, thus reducing the need and added expenses of resubmitting denied claims, a process that can minimize revenue. It also creates a concise picture of the patient’s financial situation, an insight that allows for a better understanding of a patient’s financial circumstances and allows for customized financial counseling in later processes.
Patient Encounter Processes
The data collected during the interaction between the doctor and patient informs a number of processes. Accurate data for medical coding and transcription, the classification of the diagnosis, case management is critical to having an efficient billing process and filing clean claims.
Back-End Processes
The efficacy of back-end processes, which include claims adjustments, collection of cash, posting of payments, management of account receivable and management of denied claims, depend heavily on the data collected during the first two stages. The analysis of the data can help streamline the processes of the end of revenue cycle so that each patient’s particular financial situation is addressed with the appropriate remedy. Claims can be processed faster, and denials can be addressed more promptly. Collection procedures also can be improved by using the data to determine which methods produce better results.
The Benefits of the Improved Processes
A revenue cycle that uses the data as a guide for process implementation can assist a healthcare organization by:
- Providing a complete and critical view of the organization
- Enhancing improve financial performance
- Increasing patient safety and patient satisfaction
- Making it easier to detect the procedures that create the most revenue
- Leveraging the data collected to lower or prevent claim denials
- Allowing for better compliance with evolving laws and medical regulations
Optimal revenue cycle management utilizes the data collected throughout the lifecycle of patient contact. The resultant, improved processes of the data-driven revenue cycle can enhance a healthcare organization’s operational resources and increase profit margins.
