As a result of the pandemic U.S. healthcare faces staggering revenue losses.
"The pandemic could cause U.S. hospitals to face between $53 billion and $122 billion in revenue loss this year, according to a study from healthcare consulting firm Kaufman Hall commissioned by the American Hospital Association." Source: Becker Hospital Review
This decline puts tremendous pressure on medical revenue cycle management (RCM).
The key to rapidly achieving sustained net operating margin is optimizing the revenue cycle through better information management.
Top performing hospital systems are using data tools to spend less money on critical tasks like:
But the proliferation of new "artificially intelligent" software solutions with vendors more focused on hype than results has muddied the technology waters.
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.
This article discusses several ways that tech such as machine learning or natural language processing - and logic-based solutions like robotic process automation / intelligent document processing - are being used to increase net revenue:
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.
Automating insurance verification and eligibility workflows ensures more time is spent getting claims right the first time.
Accurate data entry of patient demographic information is critical for claims processing. Strive to create workflows that validate information and flag any record missing documentation in order to have accurate data and minimize manual entry.
Intelligent software platforms can help with this, as they read forms and recognizes checkboxes without requiring complex templates or human review. They streamline any paper, digital, or mixed content registration processes.
They extract patient data from EOBs and migrate it to billing applications or electronic files for posting. As a result, you can easily achieve accurate integration of day-forward records with validation and patient look-ups.
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.
Retrospective denials are an industry silent killer of net revenue and leave providers vulnerable if they don’t act on a timely basis.
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.
Using a retrospective denial platform empowers providers against retrospective take backs by quantifying risk and enabling timely action. It boosts efficiency by:
Support realistic cash flow projections based on cost calculations by
utilization and staff work time.
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.
This article was last updated 4/29/2021.