Focus on Healthcare: Tips for a Healthier Revenue Cycle

Healthier Revenue Cycle

Healthcare providers are not only committed to delivering quality care to their patients and insurees, they must also maintain a streamlined revenue cycle to promote a healthy bottom line. But often, largely due to process deficiencies and avoidable errors, a considerable amount of revenue is left on the table. Healthcare organizations fail to capture as much as 5 percent in net revenues because they lack effective controls to mitigate financial, regulatory, and operational risks.     

This is driving the need for solid processes — and additional talent — to help improve efficiency and performance.

Here are some tips to help you with three key aspects of the revenue cycle: managing claims, payment collection, and cutting bad debt, along with some ideas on upgrading your staff resources.

Collect Upfront

Collecting payments for overdue bills is a key part of your revenue cycle. Partly as a result of the Affordable Care Act (ACA), more patients have high-deductible insurance plans. A decade ago, healthcare organizations collected 5 to 10 percent of their revenue from patients, and today it’s closer to 30 percent or more.  

This means that healthcare organizations like yours will have to step up collection activities. Collections don’t have to be an after-the-fact, dialing-for-dollars activity. The first step is to communicate with patients upfront about costs of treatment, how much insurance will cover, and payment responsibilities. Collection processes should include informing patients about financing options and setting up easy-to-use online payment systems.

Better Claims Management

If you want to check the health of your revenue cycle, take a hard look at your denied claims. In some healthcare organizations, 25 percent of claims are declared unclean, rejected or denied by insurance companies, and some of this revenue is never recovered. Ideally, claim denials should only amount to less than 3 percent of your revenues. Claim denials can have a noticeable impact on revenue, and, while appealing denials is an option, it’s a time-consuming, lengthy process and can impact profitability.

How do you resolve the problem? Start by educating employees so that they gain a complete understanding of the full scope of the revenue cycle. Also, consider implementing tighter processes upstream — starting at patient access areas — to ensure accuracy in capturing relevant data. Additionally, software tools that automate claims denial workflows can greatly enhance your organization’s ability to get reimbursed for services.

Cut Bad Debt and Increase Revenues

In 2013, the amount of uncompensated healthcare in the U.S. amounted to $49 billion. The ACA is likely to help reduce bad debt by expanding healthcare coverage, but it won’t make the problem go away entirely. You’ll want to engage qualified professionals who can come up with innovative solutions, such as financial screening of patients in advance of medical treatment, low-interest loan programs, and systems to track and report on all the details of complicated patient accounts.

The Right People to Set You on Course

The need for providers to perform at a higher level (i.e., increase revenues) has prompted many organizations to upgrade their staff resources, including engaging consultants and temporary professionals. But this, in turn, has led to a shortage of revenue cycle talent across the industry.

This can be a key barrier for healthcare providers that lack the time or resources for a lengthy recruitment process. As a result, many are turning to specialized staffing firms for consultants and temporary professionals who have extensive revenue cycle experience, are conversant in the latest technologies, and can thrive in a constantly changing environment.

Get the Help You Need

Developing and implementing practical strategies to improve your revenue cycle processes is a big job — and you can’t do it alone. You’ll want to supplement the tips here with advice from seasoned consultants. They can apply their knowledge and experience and can help you execute creative solutions to boost your organization’s financial health. 

Thinking about bringing in temporary professionals to help with your revenue cycle? Learn more about working with Accountemps here.