Healthcare providers face a daunting challenge of reduced reimbursement rates and an increased rate of denials. New challenges constantly emerge, such as the rapid industry evolution, high rates of healthcare regulation changes, and the rise of value-based care and consumerism. As a result, several new revenue cycle service providers are using best practice solutions to address these challenges.
Along with continuous increased rates of denials comes the issue of bad debts, which is a growing concern for healthcare providers. The growth in business process outsourcing continues to accelerate as the global economy regains momentum. According to an estimate by Citibank, bad debts could reach up to $200 billion by 2019. Some of the factors contributing to the growing bad debt problem in the healthcare industry include: an industry shift towards HDHPs and consumer-oriented plans, higher deductibles and co-payments for privately insured individuals, and the presence of many uninsured individuals (even though the number of uninsured persons are decreasing). When it comes to reducing bad debt, it is crucial to reduce denial rates with the right service provider.
Identification and management of denials and underpayments is a significant challenge for many providers today. It is important to identify a vendor that can improve efficiency and effectiveness as well as the bottom line. As revenue cycle management becomes more challenging by the day, there are several strategies that provider CFOs and healthcare administrators can adopt
Outsourcing your revenue cycle to a seasoned services provider can help improve both your top as well as the bottom line. However, choosing the right service provider can be tricky and requires careful consideration.
Here are a few traits that your revenue cycle services provider should demonstrate:
Focuses on improving your revenue through compliant processes
While the task of insurance paper is monumental, healthcare facilities miss billable charges or what is known in the industry as discharges not fully billed (DNFB) – or lost charges. If an organization’s bill does not fully account for all services provided to each patient, its financial health will suffer.
A good revenue cycle services partner can evaluate your discharges on an ongoing basis and provide you valuable feedback on the undocumented services which result in these lost charges.
Lowers your cost to collect
In-house and onshore billing processes are often costlier than a globally delivered revenue cycle solution. A seasoned revenue cycle outsourcing services provider can effectively address your revenue cycle with greater rigor for identifying trends and patterns in your receivables, addressing issues, and extracting value from your revenue cycle with far lower costs.
Helps you stay compliant with regulatory norms and improving quality
Look for third-party vendors who have a strong information security management system, understanding of and demonstrable practices to adhere to HIPAA compliance norms. Periodic and ongoing HIPAA training for employees is essential to ensure compliance with regulation. It is also essential to have a quality and regulatory team which does a periodic audit and ensures that compliance is met within the organization.
Deploys a trained workforce
The implementation of ICD-10 coding standards poses new challenges for healthcare providers. Updates to existing systems to both input and process new codes, as well as the lack of mapping between ICD-9 and ICD-10 led to the rework of existing medical and claims information, thus leading to a processing problem for payers and providers.
A seasoned outsourcing partner will provide an effective training program for its revenue cycle workforce including certification programs for coders.
Manages by the numbers — focuses on revenue cycle KPIs
Industry organizations such as the HFMA can provide you with effective indicators of performance such as the Revenue Cycle Keys via their MAP program, but operationalization these in internally managed RCM processes is easier said than done. Revenue cycle outsourcing partners should help you to objectively look at your revenue cycle using appropriate Key Performance Indicators (KPIs).
Ensures effective follow-up with payers
Billing service providers understand the necessary documentation required to obtain optimal reimbursements from Payers and reduce the days in A/R through timely and effective follow-up and claim adjudication. Not only do they look for opportunities to improve the A/R performance but also bring you useful feedback that can help you collaboratively address gaps in documentation to reduce denials and improve collections
Automation. Automation. Automation.
With an increased adoption of this practice by physicians and hospitals, the need to keep up with a digital system is more and more pressing.
When it come to the role of technology and automation, a revenue cycle management partner presents the most significant potential for improvement.
Helps you scale your business
Choose a revenue cycle partner with a track record of scaling up the workforce, and ability to train, retain and retrain billers and coders. With efficient recruitment, training, and resource allocation, you will be able to grow at an aggressive pace. Furthermore, outsourcing can help you increase your flexibility, savings, focus, access to international experts and operating hours compared to an in-house team. A proven service provider will give you full assurance to support your growing operations. Further, globally based outsourcing companies can give you access to a workforce that is available to you throughout the 24-hour day.
Collaborates effectively and is transparent in reporting the facts
In an increasingly digital world, the number of billing services providers who are yet to embrace technology to provide the most up-to-date information on the performance of your revenue cycle can be surprisingly few. While technology is a critical factor for an efficient RCM provider, the right people are equally just as imperative for a fully collaborative and transparent system. Choose a service provider that invests in giving you effective data-driven updates on the health of your revenue cycle using portals and augments that information with effective account managers who are aligned to your organization’s business objectives.
Selecting the best-fit revenue cycle management services provider is critical to your organization's success. When denials go up, bad debts and loss of revenue become a major financial burden for providers. Remember that when you are looking to outsource your revenue cycle processes, you are looking for an expert, and you should choose wisely. A service provider that brings the right people, process, and technology together to streamline your revenue cycle will elevate your organization to the next level and bring forth not only just efficiency but also financial opportunities.