Virtual healthcare is automating many tasks – both clinical and non-clinical. But in the era of value-based care, revenue cycle experts will always be in demand. As healthcare moves quickly along the digital path, the revenue cycle often faces challenges. Let’s examine some current trends and how revenue cycle experts are primed to lead organizations in adapting.
Assessing the explosion of telehealth
With the beginning of the COVID-19 pandemic came a rapid increase in virtual care. Although the growth of telemedicine and its benefits are undeniable, it can pose challenges for the revenue cycle. One of those challenges includes how a provider has to “rely on a patient’s description and interpretation of their symptoms to try to make a diagnosis without the benefit of testing and physical examination, as at an in-person clinical visit.”
Without complete background information, providers can face difficulty as they gauge their patients’ acuity and complexity. That can make it difficult to maximize the revenue cycle.
Although it is improving, telehealth saw challenges when it came to applicable billing codes. CMS has now released updated guidelines for telehealth billing that ensure a competitive rate for telehealth versus in-person visits.
Successful telehealth programs that experienced few hitches in the revenue cycle are well integrated with an EHR system. This allows providers as well as coding and CDI professionals to have more complete and accurate information about the patient, a critical aspect of securing the revenue cycle. Clinics that have chosen low value platforms may not be truly reaping the benefits of telehealth and instead may be losing revenue. Interoperability is the key to maintaining revenue throughout a such transitional period.
Recognizing the shift in care paradigms
As healthcare continues to become more digital, it is also changing in other important ways. Urgent care centers and virtual care options have successfully helped to drive down ED volumes in some areas, especially non-covid related visits. Healthcare systems continue to look for ways to maximize revenue, relying more and more on revenue cycle experts who understand the changing climate and practices.
This shift is an important indicator of a wider trend – one that takes us from sick care to health care. Healthcare organizations are looking towards the future and providing a proactive approach rather than a reactive one. Identifying chronic diseases early on and managing them will be a key paradigm shift and focus for payers.
Care is also becoming more and more specialized – even in traditional “one size fits all” healthcare settings like the ED and urgent care. More communities are seeing special offerings like orthopedic urgent care and pediatric ED centers. These specialized settings provide more targeted, personalized treatment and fewer follow-up visits than the generalist approach.
With these changes in mind, it is imperative to have experienced revenue cycle professionals on the team; their expertise is needed to help ensure organizations maintain a robust and complete revenue cycle that works at peak performance to achieve its financial goals. They support streamlining processes, integrating best-practice workflows, and monitoring key performance indicators to mitigate lost revenue and discover new opportunities for revenue enhancement.
Driving organizational efficiencies
Technology such as Robotic Process Automation (RPA) is set to make inroads into the healthcare space, with 15% of healthcare revenue cycle leaders planning to invest in this technology in the future. The technology was designed in the business world and has been heavily utilized in banking and financial sectors to streamline operations. RPA allows repeatable, mundane tasks to be automated. The application must configure the software to process certain transactions, manipulate data, or communicate with other systems.
An RPA process in a healthcare revenue cycle setting might look like insurance verification, prior authorization, or claims administration. The technology has the advantage of working 24/7 and helping to reduce human error. But before implementing an RPA investment, healthcare leaders will need to assess where and how this will affect existing staff.
In a scenario where highly repetitive processes can be done automatically, revenue cycle experts can then turn their focus to more complex and collaborative tasks. Hospital leaders can recognize that there is always room for improvement in revenue cycle; however, finding the time to take the deep dive into improvement processes is difficult. Embracing experts in the field and empowering them to tackle such processes are crucial first steps in evolving organizations’ approaches to:
- coding and audits
- clinical documentation improvement
- contract analysis
- reduction of denials
- system integration
Another vital role that revenue cycle experts can play is moving RCM functions out of the back office and into the daily mix. Revenue cycle is no longer just an activity that takes place behind the scenes; doctors, mid-level providers, nurses, coders, case managers, and many others also have important roles in boosting revenue and optimizing profitability.
Of course bedside providers are focused more on care, but it is important that these clinicians also understand the roles that documentation and other revenue cycle activities like pre-approvals and coding play in the continuum. After all, if hospitals don’t maximize revenue, operations can be affected in many ways – including staffing and other resources.
One thing seems to stay constant in the healthcare world – and that is change. Although digital tools and technology are being introduced and deployed rapidly, the human intelligence factor will always be needed. Revenue cycle experts can continue to learn and guide the future of healthcare in significant ways during the journey forward.
Build your team of experts today
If you’re a healthcare leader interested in how revenue cycle experts can improve cash flow and reduce cost to collect across the spectrum. Team Harmony is ready to partner with you. Our experts will:
- assist with change management
- initiate strategic directives
- drive overall departmental performance
- create a patient access strategy to better engage patients at the point of service
- reduce risk, increase collections, and boost satisfaction levels
- tackle the complexities of your denials and identify root causes
- focus on A/R most likely to yield immediate cash flow, resolve at-risk receivables, submit unbilled claims, and manage denials and appeals
- prioritize and collect third-party and self-pay receivables
- manage patient financial service responsibilities to help improve A/R operational performance