Healthcare providers are faced with the care of more than just their patients. They also have to manage their cash flow.
Changes in the U.S. healthcare system over the last several years have made it more necessary than ever to automate; using advancing technologies and processes to improve both patient care and revenue cycle management.
Better IT, better data
The right automation, which begins with an “end-to-end” system, improves the flow of the healthcare process, from intake to billing.
“Advanced technologies, in tandem with improved workflows and better data,” says John Andrews, writing for Healthcare IT News, “have resulted in RCM systems that encompass the entire healthcare enterprise.”
Given the right tools, providers can improve their cash flows by arranging for payment at the start of the process, quickly determining eligibilities, and filing clean, accurate claims.
“With the fee-for-service business model changing to prospective payment and value-based care, healthcare organizations are undergoing a cultural shift that dramatically alters their approaches to patient intake, eligibility verification and claims processing,” says Andrews.
The trend, say experts, is toward bundled payment systems, which, together with other trends in U.S. healthcare, will ultimately sound a death knell for fee-for-service models.
While the rollout of ICD-10 and other healthcare IT innovations are pushing the industry toward process improvement, with a higher emphasis on quality of care, as well as in record-keeping, arguably this is resulting in increased difficulty collecting payment.
Managing the revenue cycle given the trend involves quality metrics, and educating providers on reporting. But this, too, comes with its own challenges. Different payers tend to focus on different metrics, for example, which makes it next to impossible to implement a uniform model.
Emphasis on both ends
“RCM specialists agree that patient intake is a critical part of the revenue cycle process and that if they aren’t emphasizing it, they need to do so immediately,” says Andrews.
Emphasis must be placed on the front line: collecting deductibles, co-payments, and eligibility authorizations. Authorizations remains one of the health IT aspects that is critically behind in process improvement, according to experts.
On the back end, clean claims remain the key to prompt payment. This is essential revenue cycle management. Getting information earlier, say experts, leads to getting more done and getting it done faster.
Ironically, increasing automation has not resulted in a simpler process. But it can be used, certainly, to improve the quality of data tracking, storage, and reporting. In the end, RCM and patient care will increasingly rely on this improvement.
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