7 Ways That Tech is Powering Medical Revenue Cycle Management

by Jesse Spencer | October 17, 2018

Operating earnings is on the decline for many U.S. hospital systems.

Two-thirds of hospital systems surveyed in a recent Navigant survey show operating income erosion from 2015 to 2017. At a cost of $6.8 billion, the decline is putting tremendous pressure on medical revenue cycle management (RCM).

healthcare rcmAdd to that the fact that many health systems are adopting value-based payment models and becoming Accountable Care Organizations and it’s clear - management of information is more important today than ever before.

The Missing Piece of Tech to Optimize Your Medical Revenue Cycle Management

Top performing hospital systems are using data tools to spend less money on critical tasks like data input, healthcare claims processing, and supply chain logistics. But the proliferation of new "artificially intelligent" software solutions with vendors more focused on hype has muddied the technology waters.

medical coding revenue cycle managementWhat's needed today is intelligent connectivity between core hospital systems - solutions that empower data strategy and optimize the
revenue cycle. Lean revenue cycle management is a methodology that ensures each step in the process is valuable, optimized, and maximizes resources.

For many healthcare organizations, intelligent connectivity between
upstream and downstream software applications is the crucial missing piece. Today’s advanced artificial intelligence software brings a new level of connectivity and interoperability.

Be a Disruptor Do More with Your Data

7 Examples of Tech Powering Medical Revenue Cycle Management

This article discusses several ways that tech such as machine learning or natural language processing - and logic-based solutions like robotic process automation - are being used to increase net revenue:

  1. Insurance Verification / Eligibility
  2. Data Entry - Patient Demographics
  3. Medical Records / Billing
  4. Claims Processing
  5. Retrospective Denial Management
  6. Managed Care Contracts
  7. Supply Chain

1. Insurance Verification / Eligibility

Manual insurance coverage verification is error-prone and costly. Healthcare centers that don’t collect deductibles upfront, or collect the wrong amount, suffer huge revenue losses. This is an especially critical situation as more patients have higher deductibles and maximums.

revenue cycle management process in medical billingLean medical revenue cycle management dictates that more time should be spent on eligibility and claim acceptance before claims are ever submitted. 

Automating insurance verification and eligibility workflows ensures more time is spent getting claims right the first time. 

2. Initial Data Entry - Patient Demographics

Accurate entry of patient demographic information is critical for claims processing. Create workflows that validate information and flag any record missing documentation. 

An intelligent software platform reads forms and recognizes checkboxes without requiring complex templates or human review. Streamline any paper, digital, or mixed content registration processes. 

3. Medical Records / Billing

medical revenue cycle management softwareMedical RCM systems can also be improved by eliminating manual data entry through intelligently processing electronic and paper explanation of benefit forms (EOBs).

Extract patient data from EOBs and migrate it to billing applications or electronic files for posting. Easily achieve accurate integration of day-forward records with validation and patient look-ups. 

4. Claims Processing 

Another way that modern tech is boosting lean medical revenue cycle management is by automating data entry / extraction on all standard claim forms and attachments.

High accuracy is achievable with solutions using validation rules to ensure billing, accounting, and practice management applications receive the most accurate data with very little manual effort.

Learn More About Intelligent Document Processing

5. Retrospective Denial Management

Retrospective denials are an industry silent killer of net revenue and leave providers vulnerable if they don’t act on a timely basis.

medical rcmThese types of insurance denials or “take backs” do not pass through routine electronic channels (835), reversing revenue from paid claims for discharges that may have taken place months or years prior.

Detecting these letters and notices and acting upon them is mission-critical for safeguarding net revenue.

An audit at one health system uncovered $12 million in annual take backs from retrospective reviews. The only way to manage take backs is to capture and route time-dependent correspondence to office staff for immediate and intensive follow-up. In the case cited, losses were incurred due to the timeliness of follow-up with internal operations. Many providers experience this time and time again.

Utilizing a retrospective denial platform empowers providers against retrospective take backs by quantifying risk and enabling timely action. It reduces time to process, eliminates significant lost revenue, and progressively builds intelligence by payor to help the provider continuously adjust workflows in response to payor changes in payment practices.

6. Managed Care Contracting

Ensure managed care contracts are profitable and not causing a disproportionate share of administrative overhead. Intelligent software can easily analyze contracts for appropriate and reasonable language regarding Payors, Products, Covered Services, Claims, Prior  Authorizations, Eligibility, Audits, Renewal Dates, etc.

Support realistic cash flow projections based on cost calculations by
utilization and staff work time.

7. Supply Chain Logistics

Top performing hospitals have reduced supply chain costs by 17.8% –  up to $9M per year – by leveraging evidence-based protocols and data analytics. These methods of medical revenue cycle management reduce pricing variances and product use while increasing positive clinical outcomes.

Streamline supply chain workflows and ensure accuracy by performing automated validations on vendor and utilization data.

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