Revenue cycle management (RCM) is one of the most crucial aspects of running a successful healthcare organization. In a nutshell, the RCM process ensures that healthcare providers get paid for their services and that the healthcare organization’s financial functioning remains profitable and healthy. 

Lori Intravichit, CEO of Sunlit Cove Healthcare, said:

The recent COVID-19 pandemic has posed a unique set of challenges to RCM in healthcare organizations, as the focus has shifted from a reimbursement-based model to relative value-based care. Healthcare organizations must now incorporate value-based reimbursement into their RCM processes while securing they get the most out of their reimbursements. In addition, the need to provide quality, patient-centered care has become essential. Healthcare organizations must now focus on improving patient experience and satisfaction while still providing the highest quality care.

While there is no one-size-fits-all solution for RCM, there are five overarching challenges that all healthcare providers face:

1. The Revenue Cycle Begins with the Patient

The first challenge healthcare providers face with RCM is the beginning of the revenue cycle – the patient. Having an effective patient intake process is crucial to the entire cycle. When patients do not provide all the necessary information, and/ or the manual process is slow and difficult, it will lead to delays and inefficiency.

To address this challenge, healthcare providers can simplify their patient intake process by utilizing intuitive patient portal technology. This technology allows patients to seamlessly provide necessary health information online and helps providers capture the data quickly and accurately. Automated patient and provider messaging systems are a great way to ensure effective communication throughout the revenue cycle.

Read more about Digital Admissions and Next Step For Healthcare Facilities, and find out more about our Process Improvement services and Hyperautomation With Artificial Intelligence.

2. The Importance of a Robust Payer Network & AI Technology

The second challenge with RCM is having a robust contracted payer network. Having a well-connected payer network is key to maximizing the efficiency of the system and decreasing reimbursement time. Payer networks that are linked to all the relevant payers is necessary to ensure that the provider is reimbursed in the right amount, and in a timely manner.

In addition, providers need to start utilizing newly available technology, such as artificial intelligence, to improve the efficiency of their payer network. AI-driven software can help streamline existing processes, as well as identify errors and duplicate claims before they are submitted to payers. This can drastically improve the efficiency of the process and decrease the number of days in accounts receivable.

Find out more about How To Get Your Healthcare Workforce On Board With Artificial Intelligence.

3. Denials Administration

The third challenge that healthcare providers face with RCM is denial management. Denials are foreseeable and can be caused by a variety of reasons, such as incorrect coding or lack of authorization. Denials can be avoidable by utilizing appropriate processes that help to minimize the volume of rejected claims.

This includes having a systematic approach to coding and careful and deliberate claims submission practices. Of course, reducing errors is also a must in order to minimize denials. This can be done by utilizing automated coding tools and continuously updating provider networks to ensure accuracy. In addition, providers can also implement programs to track denied claims to identify the root causes of denials and address them. This includes identifying patterns and trends in the claims data and using data analytics and predictive modeling to anticipate denials before they happen. Providers can also use automated denial management tools to improve the appeals process and track the root cause of denied claims.

4. Increasing Patient Financial Responsibility

The fourth challenge that healthcare providers must face with RCM is the patient financial responsibility. As deductibles, copayments and coinsurance continue to rise, more and more of the financial responsibility is shifted to the patient. Providers must find ways to collect patient payments while ensuring the patient experience is not compromised.

To address this challenge, providers can start utilizing patient-centric systems that provide insights into patient data, such as their insurance information and payment history. In addition, providers must initiate strategies to increase patient engagement and education. This includes providing easy-to-understand and easy-to-navigate patient portals, as well as incorporating interactive tools such as cost estimators and payment calculators into the patient experience. By providing transparency into cost, payment options, and payment plans, patients are more likely to pay their portion of the bill in a timely manner.

Read more about RCM Billing and Collections. 

5. Improving Payment Posting and Accounts Receivable

The fifth challenge associated with RCM is improving payment posting and accounts receivable (AR) management. This includes increasing the accuracy and efficiency of the process, as well as minimizing the time of accounts receivable. To address this challenge, providers can start utilizing automated payment posting software and AR tracking tools. These tools can help streamline the process, as well as ensure accuracy in the data.

In addition, providers should also focus on increasing transparency into AR management. This includes providing clear and easy-to-understand explanations of charges, as well as setting expectations with patients and payers on when payments are due and when they can expect to receive their reimbursement. This can help significantly shorten the time of accounts receivable, as well as increase accuracy in payment postings.

Conclusion: Overall, improving the efficiency of the revenue cycle is an ongoing challenge. Healthcare providers must continuously monitor and update their processes, as well as utilize new and emerging technologies to ensure success in RCM. The five challenges discussed above are just a few of the many that providers face in their day-to-day practice. With proper planning and strategies in place, healthcare providers can optimize the revenue cycle and ensure the success of their RCM system.

Sunlit Cove Healthcare’s team can not only speed collections, identify revenue opportunities, and control denied claims but also add scalability and revenue cycle automation. We look at each process and pinpoint possibilities as opposed to one size fits all strategy. We provide these services on as needed basis for a reasonable rate. No need to hire staff as volumes shift with the constantly changing environment. Contact us or give us a call at (727) 278-3009 to get started.

Start today and schedule your free process review!

Free Process Review Services

Sunlit Cove Healthcare Consultants

We provide management and consulting services to help healthcare businesses run efficiently. Navigating the dynamic and complex revenue cycle management is a challenge for many health plans, health care vendors, and providers. Our consulting services are available to assist with your day-to-day operations and provide expertise in growth and change management. We manage all aspects of your enterprise from the development of the revenue cycle management process to the completion of your business cycle.

Revenue Cycle Interim Management: