"Financial fitness is not a pipe dream or a state of mind. It’s a reality if you are willing to pursue it and embrace it."
Financial intelligence is not something that is confined to pure entrepreneurial ventures, but is something that needs to be inculcated and practiced by everyone alike – and healthcare is no exception. Deploying an effective Revenue Cycle Management system is pivotal in providing effective value-based care while ensuring the financial solvency of the healthcare business. An efficient revenue cycle system achieves this by reducing overhead costs and duplications of tests and other services and at the same time raising patient satisfaction.
So what is Healthcare revenue cycle management all about? To put it in simple terms, it is the financial process that healthcare organizations both big and small, use to manage administrative and clinical functions associated with claims processing, payment, and revenue generation. This encompasses a series of steps, starting from the time a patient makes his or her appointment to seek medical services and ending with collecting all the claims and payments to be made by the patients.
The role of the administrative staff is very important here since they need to handle the pre-registration aspects like creating the patient account including details of their medical history and insurance coverage, thus providing the groundwork for billing and collecting the claims efficiently and effectively. Next comes the submission of claims to private or government payer for reimbursement. But even at this point, there is a lot of back-end office tasks associated with claims reimbursements, involving statement processing, collections, and handling claims denials. This is followed by evaluating claims by the insurance companies and accordingly reimbursing healthcare organizations for their services depending on the patient's coverage and payer contracts. Any other expense falling outside the purview of insurance coverage of the patients is usually collected from the patient.
This entire revenue management cycle is tedious and error-prone leading to a lot of delays, though the goal of healthcare revenue cycle management is to develop a process that enables collecting the entire amount as quickly as possible for the services provided. Healthcare revenue cycle management is often mired by a lot of challenges - one of the biggest challenges is collecting payments from patients at or before point-of-service, which isn’t easy due to reluctance and/or lack of affordability from the side of patients. Also, tracking a claim through its entire lifecycle can be arduous and revenue leakage can be the norm since it is difficult to determine the origin of an issue and resolve it quickly. This mandates staff training and regular employee education programs to achieve a better return on investment by reducing human errors, effectively managing claim denials and developing procedures for quickly resolving claims reimbursement issues.
It is these concerns that healthcare IT solutions based on Big Data Analytics, Machine Learning and Data Sciences can successfully address. With more payments being tied to value-based care models, healthcare organizations are required to report on numerous parameters for quality care, patient satisfaction, robust healthcare IT usage, and healthcare costs, so that they receive maximum reimbursement. Big data analytics and Data sciences can help healthcare organizations manage large volumes of data and inform employees of key performance indicators and revenue cycle management goals, using dashboards and alerts. These coupled with machine learning can also help predict claim results by tracking its lifecycle.
Big data analytics and Deep Learning have already been doing the rounds and have the potential to transform healthcare solutions in a much bigger way than what appears to the human eye today.
Health Information Technology and India