U.S. healthcare providers need to collect every dollar owed to them. As their reimbursement models rapidly evolve, you may be asking, “Is it time to replace our revenue cycle management (RCM) solution?”
Experts estimate that if U.S. hospitals do nothing to address the swiftly changing financial environment, they could see a 19% drop in margins over the next 10 years.
Based in part on the HIMSS AnalyticsTM index and other observations, we developed a checklist of the core components of a healthy financial system.
If your RCM solution can’t do these things, it may be time for a change:
1. Offer web services to patients for convenience – Can your patients pre-register, self-schedule and pay bills online? These online conveniences are becoming more important to consumers and help speed the billing process.
2. Verify insurance eligibility in real-time to reduce risk – Your staff and patients should know which services insurance may not cover. Knowing this information in real-time is important.
3. Use rules engines to improve accuracy – Intelligent automation helps us stay on track. It can double-check if the patient owes a co-pay at registration. It can compare claims against contractual terms to identify errors. Best of all, rules can accomplish these tasks more consistently, more accurately and more rapidly than manual processes.
4. Integrate clinical and financial information for faster billing – The ability to share information across care settings enables the provider to capture more charges and prepare for bundled payments and Accountable Care Organizations (ACOs).
5. Work directly with payers to improve efficiency – Some organizations use a third-party clearinghouse to submit claims to payers, accept claims from payers or post payments against receivables. Your claims process will be more efficient and less expensive with an RCM system that can manage these tasks.
6. Provide electronic funds transfer (EFT) for better cash flow – EFTs that third-party payers send directly into your bank account can not only improve cash flow, but are better for your financial reconciliation process.
7. Enable flexibility to address specific needs – Financial teams should be able to quickly build and execute new workflows. For example, a team could design prompts to help customer service representatives quickly answer patient questions about invoices, specific to that organization.
8. Offer an Open architecture for better payment coordination – A service-oriented architecture (SOA) becomes increasingly important in today’s financial environment. For example, if different providers need to share cost and quality information for bundled payments, they can do that easily with an SOA. Or, as hospitals acquire physician practices, an SOA enables them to handle different kinds of claims forms. There are far more options with an SOA than in a traditional RCM system.
To learn more about new revenue cycle management solutions, you can download a recent white paper.
Editor’s Note: John Dragovits and other healthcare IT executives provide more best-practice rev cycle strategies in a recent article for Health Management Technology.