Revenue cycle management is the process of managing claims, payments and revenue generation, and the use of the technology to track the claims process at every point of its life so the physician performing the billing can follow (view) the process from start to finish and address any issues as they arise. A soundly managed RCM process allows for a steady stream of revenue for a healthcare organization.
The process, though, includes keeping track of claims, ensuring payments are collected, and that the organization quickly addresses denied claims, which can cause tremendous amounts of problems related to missed revenue opportunity. Revenue cycle, obviously, encompasses everything from determining patient insurance eligibility and collecting copays to properly coding claims. Time management and efficiency play large elements in
revenue cycle management, and the cycle also can be effected by the use of ancillary technology, like healthcare communication systems and electronic attachment solutions.
By integrating one communications platform — that allows for the ability to communication, capture and share information with patients, physicians and payers — hospitals are then able to quickly and securely exchange protected health information as needed throughout the enterprise, even supporting information capture at the point of care through the electronic health record. Lack of a centralized communication system can easily impact organizational workflow and care coordination can suffer. Communication oriented inefficiencies and challenges also lead to productivity losses.
With nearly unlimited resources being invested at each point in the revenue cycle for full and accurate reimbursement of services, hospital finances can easily be affected by something as simple as poor communication systems and a lack of communication integrity. Given that denials are some of the most obvious pain points of a hospital’s revenue cycle as they must manage funds from potential pull back from payers on submitted claims. As we know based on experience, this is a lot like having a budget and preparing for certain incoming amounts per cycle (per month, for example) only to have a series of denied claims keep payers from sending all of the paid claims your organization expected. Denied claims put a strain on the entire budget even if claims represent only a small part of the overall business income.
Cost to collect on claims represents 2.3 percent of net patient revenue, but hospitals can reduce this by significantly shortening the appeals process. Using appropriate technology routinely means hospitals often can see a significant reduction in the number of claims denied upfront as payers become aware of their ability to provide proof to overturn denials. Thus, capturing communication and bringing it into a searchable database eliminates issues with mismatched authorizations, claim denials, misplaced records and patient out-of-pocket expenses, which can add up to millions of dollars wasted a year. Centralizing communication reduces chaos; with communication systems integrated, information is available when needed and where needed for the appropriate department no matter where it is physically based in the organization. Through a central point of access to information that supports payment of claims, hospitals can eliminate back-and forth between the front end and the back end, reducing duplication and supporting efforts to quickly overturn denials.
Additionally, other factors that impede the revenue cycle are reduced. For example, lost physician orders are no longer a problem since the information is gathered and collated in the united communication system. The more accessible the hospital for physicians and their offices, the more referrals it will receive. With fax and electronic orders solutions in a single location (no longer separate “machines” processing paper) — searchable by patient and available enterprise-wide — there is no hassle for doing business with the hospital.
These factors contribute significantly to improving a hospital’s revenue cycle, and any communication challenge can be overcome through single unified communication platform. Under the current, antiquated structure of using multiple systems, including devices like fax machines, that collect communication separately (with no automated manner to collate the information) communication-oriented inefficiencies and productivity challenges arise. We see that now in thousands of hospitals across the country.
Single platform communications systems have the ability to change the way healthcare information is communicated, and has the potential to be the new normal for the health organizations. By bringing together a number of previously disparate systems, including information gathered in the EHR, all communication can be located in one common central and accessible location designed to support the sharing of and access to the
information for those involved at the point of care and in relation to claims and the revenue cycle. Hospitals leaders remain under constant pressure to collect from various streams of revenue, in part because of lower Medicare, Medicaid and commercial payer reimbursements, and rising costs of technology and patient care. Improving cash flow and keeping revenue figures stable can be achieved through better communication protocols,
which, after all, is never an impediment to care or revenue management cycles.
Lindy Benton is president and CEO of Vyne Corporation.
For more information about Vyne Medical’s innovative revenue cycle management solutions connect with a sales representative.