Healthcare Revenue Cycle challenges and how to conquer them

4 min read
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The healthcare revenue cycle has problems at each patient step, from starting with patient entry to claims, billing, payment, and collecting money. Yet, digital tools and analysis can aid providers in facing these problems.

Revenue cycle management (RCM) issues can lead to loss of revenue if not dealt with. Providers can use data, tools, and automation to handle complexity and adjust to patient changes. Here are seven main healthcare revenue cycle problems and how providers deal with them.

 Issues with Patient Access

People who use apps and websites for shopping and banking want accessible online experiences for choosing a doctor, making appointments, and doing things before a visit, like signing up and checking insurance. A new survey by Experian Health and PYMNTS found that 77% of patients who don’t use online tools for healthcare would switch to a doctor with a patient website. The digital devices at the start of your online services make a big difference in how patients get involved.

Along with correct cost estimates and easy ways to pay, digital Patient Access Solutions help doctors improve the patient experience and make sign-up more accurate. Doing things by hand needs more staff time in the beginning. Mistakes can mean insurance claims get refused, or there are problems with bills later. Doing stuff with computers makes everything simpler. Having software that patients can use on a website or a phone gives them the online experience they want nowadays.

Less revenue recovery

When people have health plans with high deductibles, they need to pay more for their healthcare. This makes it hard for them to pay the bills. More enormous statements can be confusing and cause more questions about insurance. It also means people need more ways to receive revenue. To generate more revenue and avoid losing reimbursement, healthcare providers need good plans to get the money people owe them, especially when patients must pay.

An excellent way to receive patient reimbursement is to make a plan that focuses on patients’ needs. This plan helps patients understand how much they have to pay, what their insurance covers, and how they can produce. To help patients with deductibles problems, providers should:

  • Give clear and correct estimates that show patients how much they need to pay before they get healthcare.
  • Offer different pay methods, like using cards, Apple Pay, or e-checks.
  • Help patients make plans to pay if they owe a lot of money.
  • Ask patients to pay before they get healthcare so it’s easier to get money later.

When providers need to get money from patients, they can use digital tools and data to make it easier. They can focus on getting reimbursement from accounts that are more likely to pay. They can use computers to send bills and messages automatically. They can also see if collection agencies are doing a good job.

Mistakes in Billing

Errors in billing can cause problems in the workflow. They repeatedly make the staff do the same things: sending claims, getting denials, fixing mistakes, and waiting. This also makes it difficult to collect payments. When a claim is denied, it takes 16 days longer to get paid. And things are getting worse. In 2021, 69% of healthcare leaders said denials happened more often in their organizations.

To fix this, you can use computer programs instead of doing things by hand. These programs can check claims for mistakes before sending them. This helps staff and makes it quicker to get paid.

Security Issues

Patient portals help patients. They can book appointments, see test results, and pay bills. However, as healthcare providers go digital to improve things and make more money, patient information might be at risk. Medical identity theft cases went up a lot from 2017 to 2021. Thieves like medical data because it’s worth more than financial data.

It’s super essential to confirm patients’ identities. This helps providers and patients stay safe. Identity theft messes up the patient experience and trust. Dealing with fraud costs a lot and hurts a provider’s reputation. Providers need secure tools and vendors who know about Patient Portal Security to protect patient info and keep them happy. This keeps data safe and patients comfortable.

Poor insights 

Improving RCM efficiency involves using analytics to get a clear overall picture of what’s happening in a healthcare business. This is only sometimes the usual way things are done in a busy medical practice or hospital.

Having complete data and analytics is crucial for healthcare providers looking to find and solve problems. Sometimes, different systems and isolated information can make it hard to see the whole picture and figure out why claims, billing, and payments are slowing down.

RCM Analytics combines client data with standard Electronic Data Interchange sets to find ways to make processes better. By using the right data, healthcare providers can make patient access faster, improve billing, get paid more efficiently, and work better with insurance companies.

How to overcome healthcare revenue cycle Challenges?

Outsourcing medical billing can solve revenue cycle problems. Outsourcing helps doctors and hospitals by getting experts and extra help. This makes billing and getting paid faster and better. Mistakes go down, and revenue comes in faster. It also lets staff care for patients more. Also, outsourcing to professional medical billing services brings in new tech and numbers that find ways to generate better revenue. All in all, outsourcing medical billing makes things work well, generates more revenue, and helps hospitals or doctors be financially strong.

Key Take Aways

  • Healthcare revenue cycle challenges exist at every step, from patient access to payments and collections.
  • Digital tools and analytics can help providers address these challenges effectively.
  • High-deductible health plans make patient payments harder, requiring precise estimates and flexible payment options.
  • Outsourcing the revenue cycle can help you overcome the challenges.

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