RCM (Revenue Cycle Management) Challenges: Billing and Collections

Effective revenue collection and billing can be notoriously complicated, plagued with inefficiencies, and often challenging to achieve your goals. The latest research shows that 15% of every U.S. healthcare dollar spent on Healthcare RCM is due to revenue cycle inefficiencies. In 2021 that was around US$400 billion of the annual healthcare spending going to claims processing, payments, billing, revenue cycle management, and bad debt.

One of the RCM challenges is Patient Collection.

Lori Intravichit, CEO of Sunlit Cove Healthcare, said:

We all know that collecting payment from patients after leaving the hospital is a very difficult task. Hospitals must retain financial stability in a rapidly changing healthcare market; they must develop a better understanding of patient responsibility and create more simplified methods of collecting money from their patients. The key is to combine technology with well-trained revenue cycle staff that understands the importance of timely billing and collections.

 RCM Billing and Collections Solutions:

1. Key Performance Indications (KPI)

KPIs help any healthcare organization understand the strengths and weaknesses of their revenue cycle. With the right approach, KPIs will not only help guide future decisions but also help prioritize resources and identify critical success elements. You have to make sense of this data and run consistent reports that will enable you to identify trends and patterns.

Weekly meetings with your key Management in the revenue cycle to review and understand the importance of each KPI goal is vital to success. The revenue cycle Managing staff need to understand what affects each of the KPIs in order to focus on their staff’s daily productivity on the end results.

2. Accurate Patient Information

Accurate and upfront patient information is at the heart of any successful billing department. Without it, your denial rates will only grow.

You can collect the data manually, but with today’s technology advancements, there are multiple software companies that offer automated solutions for patient data collection. The automation of the patient information that will include insurance coverage is vital to successful collection. The onsite automation will allow the staff the correct the issue on the spot to avoid back-end office denials.

3. Communication

It’s just as crucial how you talk to a patient as it is what you say. Explain your financial policies as soon as possible, follow up with the patient if there are any questions, and always use a professional, understanding tone of voice.

4. Outsource Your Billing and Collections

Outsourcing does not mean “passing the buck” in the responsibility department. Outsourcing is a trusted partnership. You should have complete visibility of the process. Your outsource partner should provide you with the performance reports outlining your denial issues. The vendor’s goal must be to reduce the denial rate by giving you feedback on denial avoidance.

Sunlit Cove Healthcare 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 727.576.2903 to get started.
Start today and schedule your free process review!

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: