For healthcare practices to scale and remain operational, they must grow and be efficient. This can be achieved by effectively using Revenue Cycle Management (RCM). This is the financial process of tracking patient care services from registration to the final payment of a balance. RCM is required in all healthcare practices to ensure revenue, financial viability, and reliable collections. Ultimately, this will aid in delivering quality care to patients. However, some of the challenges that arises from RCM consist of billing and collections difficulties, patient access, medical coding, and denial management. RCM is an intricate process bound with many difficulties often due to accounts receivable follow-ups and lack of staff awareness. According to Advanced Systems Corporation, healthcare providers lose up to $125 billion every year due to medical claim denials, coding mistakes, and missing patient payments (Rosario 1). If such RCM issues remain unresolved, it could lead to massive revenue loss.

Let us look at the challenges facing revenue cycle management in the medical industry:

Difficulties in procuring the right technology

Today, with advancements in technology and an abundance of new software, practices can stay more efficient while focusing on other tasks. While technologies exist to organize claims and reduce errors, many hospitals do not have the capital to identify or invest in the right tools that their business requires. Ultimately, healthcare staffs often depend on manual processing, which can be time-consuming and lead to many patient follow-ups. When providers make follow-ups, it often includes not hearing back from patients or collecting payments from third-party insurers.

Inefficient billing process

Healthcare providers must ensure they are collecting accurate patient records, such as registration, insurance, and medical codes. If they fail to do so, it can cost providers thousands to millions of dollars per year, impacting the revenue cycle. Financial responsibilities from patients and insurance company follow-ups can make the billing process more complicated. Patients may be uninsured or underinsured, which can leave bills unpaid. With the rise of high-deductible insurance plans, patients may less disposable income, making it more difficult for them to pay their healthcare bills. If accurate patient information is not collected, it can be difficult to contact patients once they leave the site.

Poor communication and training

Physicians and staff must be informed of the revenue cycle processes and the appropriate practices. A provider can be negatively impacted due to rejected claims, unaccounted payments, and slow turnaround. Revenue loss in the healthcare industry can shrink operations causing a decrease in utilization of inpatient and outpatient care, and a decline in patient visits. With that being said, staff must be trained effectively when it comes to tracking and securely handling patient data.

Here are some methods to overcome the challenges associated with RCM:

Start practicing with new custom software

To overcome RCM issues, incorporating software into medical practices can reduce errors and increase efficiency. Custom software is developed to suit your business and thus, can help in managing financial processes and organizing administrative tasks. Hospital management software can limit manual processing and human error. Ultimately, software and technology can increase employee productivity, ensure security and improve customer service. Payments can be collected and tracked electronically, along with updating the insurance data.

Improve payment collection process

Frequently, patients seek pricing information before requesting medical services. Healthcare practices may not provide such information, making it difficult for patients. Additionally, bills that are mailed are typically neglected and forgotten about. Resolving billing inefficiencies can reduce healthcare operational costs, increase revenue, and boost patient satisfaction. Staff must discuss financial responsibilities from the beginning with patients. Medical billing and coding software can save time and money while increasing efficiency and decreasing turnaround.

Train staff

It is integral for staff to be trained properly for decreasing patient record errors. Patients’ financial data may contradict or be inaccurate between different departments. Therefore, employees across all departments need to be trained on financial matters to improve RCM. Training such as observation, coaching, and real-world scenarios, can give staff the right knowledge when interacting with patients. Medical personnel also need to be trained on how to properly use new software. Proper training can lead to improved employee performance and can optimize healthcare RCM.

Healthcare facilities experience challenges related to revenue cycle management and each practice has obstacles that need to be addressed. Issues such as technological difficulties, inefficient billing processes, and poor communication amongst medical personnel may arise. However, these challenges can be reduced through medical and coding software and proper staff training. Overcoming issues can result in a positive impact on revenue cycle management.

Data-Core Healthcare provides end-to-end solutions for all your RCM woes. To know more about our services, custom software and products built using state-of-the-art AI/ML technologies, please contact us at [email protected]