Question

Most medical services entities do not receive cash payments, so their administrators and directors must clearly understand how to best manage the payments made by the insurance companies that are covering the medical costs of patients. Your job is to find an article that is relevant to the content of this topic. It is recommended that an article be included from a professional and reliable source. Make a summary of the concepts learned after reviewing the reading.

Answer 1

1.What are the basics of healthcare revenue cycle management?

Healthcare revenue cycle management begins when a patient makes his or her appointment to seek medical services and ends when all claims and patient payments have been collected. However, the life of a patient’s account is not as straightforward as it seems.

To start, when a patient arranges an appointment, administrative staff must handle the scheduling, insurance eligibility verification, and patient account establishment.

Pre-registration is key to optimizing healthcare revenue cycle management processes. During this step, employees create a patient account that details medical histories and insurance coverages.

“From a revenue cycle perspective, getting the most accurate information up front starts with patient scheduling and patient registration,” Gary Marlow, Vice President of Finance at Beverly Hospital and Addison Gilbert Hospital, told RevCycleIntelligence.com.

“That provides the groundwork by which claims can be billed and collected in the most efficient and effective manner possible,” he stated. “The last thing you want is getting a claim submission kicking back to them then having to work their way through the institution.”

Once a patient has been seen, it is time to create a claims submission. The healthcare provider or coder must identify the nature of the treatments received and the proper ICD-10 code. These codes signify how much an entity is reimbursed for highly specific treatments, which means that coders must select the most appropriate code to prevent claims denials.

“If you’re bringing in a certain amount of revenue, you can’t have expenses that exceed that revenue. It’s seems very basic but people don’t look at it that way.”

The provider also must complete charge capture duties, which documents services into billable fees.

After a claim has been created, it is sent to the private or government payer for reimbursement. But, healthcare organizations still need to oversee more back-end office task associated with claims reimbursements. This involves payment posting, statement processing, collections, and handling claims denials.

Once an insurance company evaluates the claim, healthcare organizations are usually reimbursed for their services depending on the patient’s coverage and payer contracts. In some cases, claims can be denied for various reasons, such as improper coding, missing items in the patient chart, or incomplete patient accounts.

For anything that is not covered by insurance, healthcare organizations must notify and collect payments from the patient.

The goal of healthcare revenue cycle management is to develop a process that helps organizations get paid the full amount for services as quickly as possible.

2.How can one be successful at healthcare revenue cycle management?

In simple terms, healthcare organizations must stay in the black and maintain profitability to be successful at healthcare revenue cycle management. In this section, we reveal some tips for maximizing revenue cycle and ensuring claims are paid quickly.

Many claim denials can be avoided by training staff on completing upfront tasks, such as using billing forms and talking to the patient about medical costs, as well as investing in revenue cycle software that automates coding and insurance verification. Healthcare organizations should also regularly track claims and investigate causes of denials.

Many providers also use big data analyticsand health IT solutions to run successful healthcare revenue cycle management programs. With more payments being tied to value-based care models, healthcare organizations must report on numerous measures for quality care, patient satisfaction, robust health IT use, and healthcare costs in order to receive full reimbursement rates from payers.

Big data analytics has helped healthcare organizations manage large volumes of information and inform employees of revenue cycle management goals, especially through the use of dashboards and alerts. Analytics can also help to predict claim results by tracking its lifecycle.

3.How does technology help drive healthcare revenue cycle management?

Health IT and EHR systems have helped to streamline and provide more accuracy to healthcare revenue cycle management strategies. Many organizations use technology to track claims throughout their lifecycles, collect payments, and address claim denials. Ultimately, these technologies facilitate a steady stream of revenue.

Approximately 4,201 hospitals have already invested in healthcare revenue cycle management technologies, which have been especially useful for handling both traditional fee-for-service claims and value-based reimbursement arrangements as the industry transitions to new payment models.

Many providers have benefitted from automating common issues with healthcare revenue cycle management, such as payer-improving payer-provider communications, recommending appropriate ICD-10 codes, monitoring medical billing processes, and even scheduling patient appointments.

While these technologies can be expensive, some providers choose to consolidate with other healthcare organizations to invest in healthcare revenue cycle management solutions or outsource some revenue cycle management functions, such as collections.

“Generally speaking, in order to strengthen the revenue cycle management, embracing technology within the revenue cycle is key,” stated Chad Sandefur, Director and Healthcare Analyst at AArete. “Having the platforms to seamlessly facilitate provider-payer interactions are really integral. In many cases, it’s mostly about bad debt avoidance. With that in mind, there are a few specific points. Some of these specific five might not be the most glamourous, but certainly on the element of embracing technology, they are critical.”

Conclusion:

Healthcare revenue cycle management is continuing to evolve and keep pace with rapid changes to the healthcare ecosystem, such as value-based care. Healthcare professionals should always be aware of how their revenue cycle is doing in order to provide appropriate care and receive appropriate reimbursement