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Streamlining Revenue cycle management with the basics

The pandemic sure did have a raging impact on providers, especially on their finances, due to prioritizing COVID care. Healthcare organizations have faced significant revenue loss, which can impact practices in providing quality care if left unrecoverable. Now that there is a steady recovery from these challenging times, this is the right moment to resolve revenue cycle management inefficiencies.

While providers are back to the usual patient care with a pre-pandemic patient volume, there is a high chance of revenue leakages that can be unmanageable if not focused upon. There are some basic yet proven methods that can be adopted by billing companies, to make their revenue cycle volatile towards any dynamic situation during the post COVID period.

Front-end process optimization

With increasing patient volume especially for elective surgeries and other care that is not a medical emergency, it is vital to ensure that processes related to scheduling, authenticating the accuracy of patient demographics and eligibility verification with payers, will ensure that claims when processed are not denied due to invalid patient registration. Another important aspect of the front-end process is documentation. Maintaining and providing medical records is of the utmost relevance if required by the payer and helps in resolving most of the denials in the back-end process.

Back-end process optimization

While front-end processes are mostly the responsibility of the provider and their staff, the entire back-end process is reliant on the medical billing team. The majority of the revenue cycle management inefficiencies are in the back-end processes. We see everywhere a lot of buzz about automation and AI for the entire process of the revenue cycle. Though it can resolve most of the lag in the process, not every practice or business can afford to invest in it. In such cases, the best way is to master the basics in-order to reduce redundancies in the process. Some simple yet highly effective hands-on work can prove to be revenue generating tactics for them to practice.

  • Data analysis: Data is just numbers; but when put-together into logical information, it shows us patterns which always helps us in identifying a flaw or a recurring mistake in the billing process.
  • Coding updates: No matter what state-of-the-art technology one can implement, without the knowledge of knowing what the correct current code to be used is, even automation will not help. Following up with coding changes does not sound to be a great strategy or may not even seem to be worthy of being called a strategy. But when not looked upon, it simply leads to denial resulting in the possibility of losing revenue. With the pandemic, there have been a lot of updates especially related to tele-health. Having a team of coders who can keep tabs on these changes and keep the technology updated, goes a long way in the prevention of denials due to coding errors. Systemization of this process is the way to tackle this tricky situation.
  • Payer updates: Capturing payer updates makes a huge difference in optimizing the back-end process. Something as simple as following up on a change in Timely filing limit, can protect revenue in a large way. The majority of payers have made changes in the requirement of prior authorization for various procedures in the pandemic. It is important to keep a check if such requirements are changing, now that we are slowly moving back to a pre-pandemic environment. Understanding such small nuances of different payers, usually helps in speeding up the revenue cycle management process.
  • Denial analysis: A majority of denials can be prevented when we dig a little deeper and understand the root cause. Once again effective use of data plays a major role. (To know about our 5-step root cause analysis click here)

When we talk about streamlining the revenue cycle management, the majority understand it as investing in AI and Automation. What we need to understand is that technology can only aid us by helping in reducing errors due to human intervention. Any of the highly trending RPA tools and software can provide paramount benefits only when the revenue cycle has an existing integrative process already in place. So, getting the basics right is all we need to ensure a successful and fruitful Revenue Cycle Management.

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