As healthcare providers get crushed from regulatory pressures on one side and financial pressures on the other. Trying to streamline care imbued in Quality, Value, and Patient Centricity, specialized technical know-how for revenue maximization becomes imperative for the success of a competitive healthcare facility.

The regulation mandates that care to be delivered based on patient centricity. In order to help health organizations deliver Accountable Care, reimbursement was strategically tied to Value based healthcare delivery. The nature of this switch over has numerous implications for Providers and they have more than one area to comply with for their long-term success.

Revenue for a health delivery setting is affected by a number of factors including the patient volume that your practice serves and its related charges, as well as reimbursements and collections. In this context, entities involved in successful Revenue Cycle Management must know about Payer Contracts and insurance company guidelines. Furthermore, extensive knowledge about the Coding process and an effective strategy for minimizing rejected and denied claims as well as expending minimal cash for reworking claims is imperative.

revenue cycle management

How Cash Flow Disruption Can Happen During the Revenue Cycle of Healthcare Organizations

In addition to securing patient information, providers of healthcare, irrespective of size, have to care about cash inflow through a healthy cycle of reimbursements. Owing to the management of numerous steps involved from the time the patient receives care to receipt of final payment in the form of reimbursement or out-of-pocket expenses, practice efficiency is compromised faster than expected. In addition, numerous steps during the Revenue Cycle add to the burden of financial process execution and even small mistakes might prove costly. These are some most likely disruptions:

  • Accounts receivable Processing and optimization could help resolve major inefficiencies and minimize chances of revenue leaks in critical areas of the Revenue Cycle.
  • Patient self-pays might not look like a worrisome statistic on the surface, however, translate into significant financial losses. Trends in Annual Payments (2012 Annual report) states that these patient payments might cost anywhere between three to five times more in terms of collections when compared to payer
  • Denials and rejections and their associated rework cost millions of dollars to the healthcare delivery setting. This can be addressed only if the workflow is assessed on a regular basis – daily, weekly and monthly. Further, successful management of denials and rejections, as well as minimizing rework costs, requires specialized expertise.

How Specialized Revenue Cycle Services Address Financial Concerns that Impact Healthcare Delivery

“The RCM market is expected to grow at a compounded annual rate of 7.2 percent from 2014 to 2019, according to upcoming data from MicroMarket Monitor.”

In today’s competitive healthcare scenario, the need for specialized Revenue Cycle Services is obvious for most health delivery organizations facing a huge array of challenges owing to industry-wide transitions. Revenue Cycle Management (RCM) helps keep healthcare facilities on track by ensuring financial success in the long run:

  1. RCM is a series of end-to-end functions, executed from patient enrollment to receipt of reimbursement to ensure that cash flows occur in a timely manner for the success of the healthcare organization
  2. Important regulatory requirements including the implementation of sound technology for Health Records, Health Information Exchange, Care Coordination and Clinical Decision Support are met successfully through the execution of specialized Revenue Cycle Services
  3. In addition to meeting financial goals for the healthcare setting, RCM allows Practice staff to concentrate single-mindedly on patient care, enforcing Quality outcomes

Cash flow disruption

Dedicated Revenue Cycle Services undertake comprehensive control of financial processes in healthcare organizations from payment collections to staff training. Revenue Cycle Management when executed through an approach, which is tailored to the healthcare delivery workflow, allows the best use of every opportunity for maximum cash inflow, from appointment scheduling to follow-up.

Based on insightful process knowledge deployed at every stage, combined with billing expertise and technology use, patient services can be delivered more efficiently and effectively for assured bottom- line benefits. In the past few decades, healthcare organizations have been undertaking a high-stress multi- tasking approach to fulfilling the needs of patients and practices as per high standards set by the CMS. Owing to the fact, that this trend will continue in the near future, with the possibility of even more stringent guidelines for Quality care delivery, the Revenue Cycle of healthcare organizations will need specialized focus for the competitive success of the organization itself.