The Benefits Of Revenue Cycle Management For Healthcare

By Megan Williams, contributing writer

Revenue in healthcare is a perfect storm of thin margins, managed care complexity, and tightening legislation. Chances are though, when you’re working with your clients, they don’t realize the full benefit potential of revenue cycle management — understandable, since the combination of technology and financial considerations can be difficult to explain.

Here are a few areas to focus on to make the task of relating the new world of revenue cycle a bit more productive for you.

Easing Integration Woes

Any provider that’s aware of revenue cycle benefits, has probably heard horror stories around implementations gone wrong (the industry is surprisingly connected, and people talk). This means, that while the tangible benefits of a strong revenue cycle technology solution are incredibly important, it’s just as important to let the client know that you not only understand the difficulties of integrating new software with their existing systems, but that you’ll also be mindful of the challenge of training personnel, disrupting long-standing workflows, and navigating the unknown bumps and bruises that come with any integration. You may have to relate this at multiple organizational levels, since the people who may think a revenue cycle solution is a great idea, are likely not the ones who’ll be facing the most change.

Focusing On Quality Of Care

Times have changed and reimbursement is influenced by much more than what services are provided. A new emphasis on quality of care has put providers in a position where it’s absolutely necessary to be able to manage how clinical outcomes impact reimbursement for all payment models. This means a need for real-time monitoring of well-chosen performance indicators. Technology that allows for this — and facilitates collaboration and communication between clinical and non-clinical departments — promises concrete reimbursement benefits.

Emphasizing Patient Liability

Mention patient liability to CFOs and you’ll have their attention. The industry has historically only be able to collect on 20 percent of patient portion within 120 days of sending the first bill. Predictive analytics have already been able to increase that number by 10 to 20 percent, and that’s just the beginning. Providers also have the option of expanding upfront payment programs, communicating patient liability as early in the payment process as possible, being proactive around self-pay accounts and balance-after-insurance liabilities, and coordinating with doctors’ offices.

Don’t Forget Record Keeping

Revenue cycle is traditionally understood to encompass tracking the flow of real and potential money through the reimbursement system. Clinical documentation though, has become a critical piece of the puzzle, and no organization concerned about healthy revenue flows can afford to ignore the importance of accurately capturing presenting conditions, illness severity and other data around the spectrum of care. Reimbursement is now directly tied to (and sometimes impeded by) case mix index, POA (present on admission) indicators, facility-acquired conditions, core measure, and provider profiles.

Like so many other tech solutions, selling revenue cycle is much more than just selling software or a service — it’s about selling organizational change that will ultimately work to the client’s benefit in navigating an increasingly complex healthcare environment.