According to the American Medical Association, healthcare providers now have denial rates of up to 40% of their total reimbursements. While 70% of these denied claims may get cleared on appeal, the rework and revisions add significantly to the costs incurred and contribute to the overall loss of profitability. Per physicians, up to $100,000 of annual revenue is lost due to inefficiencies in revenue cycle management. On average, there is a delay of 45 days in the payout of reimbursements from payer to provider. The odds are heavily stacked against healthcare providers, who are distracted from their core obligations of delivering quality healthcare to their patients.
In addition, providers face further pressure in the form of declining reimbursements due to policy, tighter regulations, lack of quality talent, inadequate technology, and errors creeping in during data processing.
Importance of Revenue Cycle Best Practices
To achieve optimal results in RCM, healthcare providers must develop a robust program that can handle the complexity of the revenue cycle process. They must implement strategies to streamline workflows, reduce inefficiencies, and improve coding and documentation accuracy. Additionally, providers must invest in technology solutions that can automate many RCM processes, such as electronic health record systems, practice management software, and revenue cycle management software. By adopting these approaches, healthcare providers can improve their financial outcomes and focus on delivering high-quality care to patients.
This white paper will guide healthcare professionals and practice administrators on implementing an effective set of best practices to modernize their organization’s revenue cycle, enabling a better revenue intake and more efficient collection of reimbursements. These best practices, categorized by the section of the RCM value chain they apply to, are actionable, and their results can be measured through very clear metrics, which are detailed in the document.
