By Katie Brenneman, Writer, Researcher
X: @KatieBWrites93
Healthcare is a field that survives on evolving along with society. Whether it’s innovations in life-saving technology or fluctuations in revenue generation, professionals in the health industry must keep abreast of these changes and adapt accordingly. Revenue cycle management (RCM) plays an important part in this flexibility and can ensure financial stability for healthcare providers and organizations.
From patient registration to claims processing, each step impacts the bottom line. However, complex setbacks can occur and make RCM difficult. Luckily, health IT solutions can help facilitate RCM and mitigate some of these challenges.
Common Challenges in Healthcare Facility Financial Operations
RCM is a critical aspect of financial operations in healthcare facilities. It encompasses a series of processes and activities that span the patient lifecycle. This includes registration, medical coding, and medical billing. Navigating the complexities of RCM in healthcare presents several common challenges, including:
- Payor denials: when insurance companies deny claims;
- Reduced insurance reimbursements: when reimbursement rates are adjusted and providers receive a different amount of payment;
- Complex insurance policies: when insurance plans, coverage limitations, and billing requirements are complex and differ from provider to provider, causing complexities in coding and documentation;
- Increased patient financial responsibility: when patients have high deductibles and are responsible for paying greater shares of their medical costs;
- Evolving payment models: when there is a shift from fee-for-service models to value-based care that includes different ways to pay, like bundles, shared savings, and risk-based contracts;
- Healthcare financial staff shortages: when skilled RCM staff aren’t available and upskilling takes time and resources.
Successful RCM requires robust systems, well-trained personnel, and effective communication with patients and payors. By addressing these challenges, healthcare organizations can achieve financial stability and enhance patient care simultaneously.
How Health IT Solutions Can Help RCM
Luckily, IT solutions are available to automate and streamline these convoluted elements of healthcare finances. Finance teams can reduce some administrative workload by automating repetitive tasks like medical coding and billing. Digital programs can also provide optimized employee training to keep them up to speed with healthcare processes, speeding up the RCM process, reducing the chances of human error, and keeping staff more satisfied and productive.
Streamlining Billing Processes
Healthcare billing can be long and drawn out, but tech can help facilitate the process. IT solutions can help with efficient medical billing, ensuring accurate reimbursements, maximum profits, and quick turnaround. Insurance claims, coding requirements, and regulatory changes can be fast-tracked by implementing some of the following healthcare financial tech:
- Automated, centralized billing systems: software that eliminates manual tasks, reduces paperwork, and speeds up claims;
- Real-time insurance eligibility verification: systems that help avoid rejections and delays, allowing providers to verify insurance eligibility before providing services;
- Medical coding tools: systems like databases and risk calculators that automate or facilitate medical coding and documentation that, combined with trained healthcare staff, avoid issues like overcoding or miscoding.
With so many patients coming in and out of hospital doors, there is an overwhelming amount of financial data that must be dealt with. Implementing a robust suite of healthcare financial tech can help speed up this process and prevent costly mistakes.
Improving Claim Accuracy
Claims management can also be streamlined with the help of healthcare IT tools. Machine learning applications in healthcare finance can automate and enhance the accuracy of various finance tasks, including claims work. Automated tools like risk management software and fraud detection software can make the claims process faster and reduce errors.
For example, algorithmic analyses of billing discrepancies and historically denied claims can inform the risks involved with the claims process and make it more efficient. Claims submissions can be tracked, approved, and rejected much more quickly than traditional methods by using these tools along with healthcare claims management software.
Enhancing Patient Payment Systems
Just as patients are rifling in and out of healthcare facilities, so is their financial information. The mass amounts of sensitive data are difficult to manage without using healthcare financial tech. Tools are available to streamline patient payments, speeding up processing and keeping their information secure. Some of these tools include:
- Mobile apps for secure medical billing payments and insurance coverage information;
- Omni-channel payment reminders and portals for patients, including emails, texts, mail, secure messaging, and phone calls;
- Automated payment options that allow patients to set up recurring billing, reducing labor costs, decreasing patient effort, and minimizing human errors;
- Electronic health records (EHR) integration, linking payment systems with EHRs to ensure seamless access to patient information to verify insurance, accurately code, and process payments.
By embracing health IT solutions, healthcare organizations can create a patient-centric environment that leads to greater satisfaction and cost savings.
The Future of Healthcare Finance Tech
Technology is driving almost every industry from 2024 on. Financial technology takes precedence in the evolution of healthcare RCM. The ultimate goal is for patients to be taken completely out of the payment lifecycle, allowing them to rest easy and have insurance claims and billing taken care of for them. This isn’t currently possible with the amount of staffing shortages and financial constraints, but healthcare financial tech is poised to change this for the better.
IT solutions that automate and refine RCM will benefit both patients and organizations by ensuring smoother, safer financial transactions and improved revenue management. This way, the focus can be on what it’s supposed to be — excellent patient care.