The most shocking fact is that US hospitals provide $42.67 billion worth of uncompensated care to their patients. It means that such healthcare organizations are bleeding revenue money, and the core issue lies at the revenue cycle management inefficiency. Is your hospital one of those rendering unwanted free services to patients? If the answer is yes, there is a need to know about Revenue Cycle Challenges in 2022.
This article will discuss 5 top revenue cycle challenges and how to overcome them in 2022, so you can run the profitable healthcare services.
Challenge 1: Ineffective Medical Coding and Collection
Are you aware of 140,000+ medical codes required for getting the reimbursements of claims? In addition, when a claim is being lodged, the coding staff must have comprehensive documentations available to them to put these code claims accurately. Unfortunately, the insurers are now scrutinizing the claims in more detail and emphasizing prerequisite payment.
All this indicates that the healthcare service providers need to have a better and more nuanced understanding of the codes and its selection, create detailed clinical documentations, and engage in a claim follow-up activity.
In fact, most healthcare practices lose out on thousands, if not millions, of dollars every year due to ineffective medical coding and collection procedures. Therefore, it is the right time to start collecting accurate patient information during the scheduling and registration. This process will reduce the occurrence of 1CD-10 coding errors. Moreover, it prevents the failure of insurance verification eligibility and eventually the revenue cycle.
It is also the provider’s responsibility to ensure and collect from the uninsured patients. Hence, hospitals need to collect the correct information of the patients while they are onsite, which will help get reimbursed from the uninsured patients.
Challenge 2: The Legacy System
In 2022, it is time to change the IT ecosystem as the previous out-dated system is forcing your practice to do most of your tasks manually with the performance of the software taking too long, and the integration between different systems is poor or absent. Therefore, there is a need to ensure that your practice must follow the updated revenue management trend of using the latest software, tools, and technology. In other words, replacing the legacy system that compromises the revenue is mandatory.
The words such as artificial intelligence, robotics, big data analytics, and the Internet of Things are no longer fancy words. Instead, these are part of the technology that can help you to optimize your medical billing and the revenue process of your healthcare facility. Moreover, it will increase your service’s interoperability, scalability, security, and reliability.
Challenge 3: Generic Software
If you want to overcome your revenue challenges, only updating the legacy system is not enough. It would be best if you had software in place that can be customized as per your services and requirements. Building single customized software for your hospital or practice can save a lot of your hospital budget.
However, the RCM challenges can further be solved with a few more custom medical software optimizations since they cater to the healthcare industry. Such software can be categorized into:
- Revenue cycle management software
- Hospital management software
- Healthcare analytic software
All these three need to be combined and integrated into your healthcare system to improve the revenue cycle. It will help you to simplify the claim payments, and follow-up process, reduce the mundane tasks by automating them and cut down on unwanted bureaucracy.
Challenge 4: Untrained Administrative and Medical Staff
Studies have shown that there is a lot of inconsistency between the departments responsible for collecting the financial data of patients, caused due to untrained staff. Often, this leads to patients getting uneven experiences in different departments and among the staff. As a result, it increases the patient churn and eventually affecting the revenue flow.
The lack of training among the administrative and medical staff contributes to revenue cycle management challenges. Even if one staff in the entire system fails to fill out the forms of the patient correctly (leading to incorrect medical billing and coding), there will be a domino effect on the system. So, when you are implementing new software and moving from the legacy system to the latest technology, it is important that the staff must be trained in the system.
Moreover, providing in-depth training to your staff improves your patient’s experience but also reduces the turnover. It also enhances your hospital’s employee retention, thus optimizing your healthcare revenue cycle management.
Challenge 5: Lack of Transparency with Patients
Research has shown that 49% of the patients decide on their healthcare facilities based on the information available about such service providers. Hence, one of the critical factors that often pose a challenge in the revenue cycle is the lack of information a patient can get about the hospital or their services. Therefore, transparency in the details such as medical billing and payment process is essential in ensuring your revenue management.
A patient-centric approach where information is readily available to the patients and the caregivers is the way to move forward. Your hospitals can quickly achieve this by implementing the right software that allows your patient assistance modules, automatic administrative tools, and improved communication channels.
For instance, online scheduling software, e-prescriptions, electronic health records allow you more accessible and effective patient communication. This further allows your administrative staff and the doctors to perform more crucial work taking care of your patients instead of performing mundane jobs.
How Can You Move Ahead?
The best way is to identify these revenue cycle challenges and follow through with the solutions. But it is easy to say than to carry out. Finding the right software, training the staff, implementing them, and bringing it altogether can quite be a challenge.
Instead, you can outsource the RCM challenges to a third-party professional medical billing company. The Market Reports’ research stated that by the end of 2023, the global healthcare revenue cycle management would reach by $23 billion.
So, why not invest in the professionals such as 24/7 Medical Billing Services who can warrant your RCM success instead of going through a trial-and-error method yourself? Call our RCM experts at +1 888-502-0537 right now.