Accuracy is often challenging to achieve. But in many industries and professions, meeting and overcoming challenges is crucial. Take for example pharmacists: they must correctly fill prescriptions or risk a patient experiencing unwanted side effects or a lack of medication adherence. Or consider airline pilots: they must digitally monitor multiple controls; making one sizable mistake could result in a disaster.
In the world of healthcare, a robust revenue cycle requires accuracy, too. From reviewing and submitting claims to performing medical credentialing and conducting charge capture, healthcare providers risk costly reimbursement delays, poor cash flow, and overall weak financial performance without accuracy.
Revenue cycle management 101
Since the revenue cycle includes “all administrative and clinical functions that contribute to the capture, management and collection of patient service revenue,” the management of its processes and procedures can greatly impact a healthcare organization. That can includes scheduling, patient registration and accounts, payment collection, and anything related to accounts receivable (A/R).
Inefficiencies in revenue cycle management (RCM) can be costly, resulting in an increased number of billing errors, lost revenue, and unnecessary administrative time and expense. In fact, about 15 cents of every U.S. healthcare dollar goes toward these inefficiencies.
To achieve and maintain a healthy revenue cycle, organizations must empower RCM experts to optimize processes throughout. A tailored end-to-end approach corrects clinical and financial operational inefficiencies across all areas of organizations; it should include patient registration all the way through to final payment of a balance. This can indeed be a time-consuming process. However, streamlining revenue cycle functions with impactful professionals and processes benefits providers by standardizing payment processing, reconciliation and denials management – all while enabling them to focus on their most important goal: patient care.
Why your organization should outsource RCM
To maintain focus on other core business objectives, many hospitals, health systems, and other healthcare providers outsource RCM services. With a collaborative partnership “that focuses on the organizational and patient needs” and “that is willing to proactively identify the right tools for patients to easily resolve outstanding balances,” organizations can easily see increased collections as well as patient satisfaction scores. This approach sets your patients, your organization, and your outsourcing partner up for success.
Benefits to outsourcing RCM services include:
- reducing cost-to-collect
- optimizing payments to help you collect more under any reimbursement model
- having revenue cycle experts on hand who can reduce errors and maintain compliance
- securing streamlined operations
- tailoring end-to-end revenue cycle management to correct clinical and financial operational inefficiencies
One report released earlier this year found that the prevalence of chronic diseases and rising expenditure on treatments are fueling demand in the global revenue cycle management outsourcing market. It also suggested that new opportunities in the RCM industry are being created by insurance companies investing in preventive healthcare, including early screenings, telehealth, and dietary consultations.
Outsourcing RCM services enables healthcare organizations providers to more easily define and monitor organizational goals and performance and measure their performance against those benchmarks. Any necessary changes or improvements in a provider’s revenue cycle can then be made by an outsourcing partner to identify and address specific issues for increased profitability.
A reliable and experienced RCM outsourcing partner has the capabilities and team of professionals to help a healthcare provider mitigate common challenges of revenue cycle management such as addressing:
- billing and collections inefficiencies
- inaccurate charge capture
- ever-evolving government regulations and industry best practices
- complex reimbursement models
- demanding consumer expectations
- lack of advanced metrics and insufficient staff training
They also can mitigate leakage due to incomplete or unbilled procedures and claims, human error, unverified insurance, denied appeals, outdated procedures and technology, and more.
Although some healthcare providers might be hesitant to outsource any financial processes, the advantages of using a team of RCM experts able to securely handle patient data far outweigh any risk. They’re able to assist providers in improving multiple KPIs that are designed to help highlight and compare key quality improvement and value metrics and facilitate insight into providers’ clinical, operational and financial performance through analysis of real-time data.
An impactful outsourcing partner can help your organization promote profitability by:
- reducing interruptions in cash flow
- increasing compliance
- helping to reduce denial rates
- improving blended encounter rates
Team Harmony is proud to deliver RCM experts who are primed to assist with change management, initiate strategic directives, and drive overall departmental performance. Our consultants enable providers to cost-effectively enlist the services of staff with comprehensive industry knowledge.
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