Changing healthcare regulations combined with evolving revenue cycle management equals a lot of shifting sand in the healthcare industry. Along with staying current on updates to the Affordable Care Act (ACA), Medicaid and other healthcare programs, healthcare providers need effective billing and tracking procedures in place. But even these must adapt to changing times and needs. Unfortunately, a lack of solid ground in these areas results in many challenges for hospital revenue cycle management. Errors are bound to happen, which hinder the hospital’s growth and service abilities. Hiring trusted professionals in this field can help hospitals address these common challenges that can definitely get in the way of treating patients efficiently. Here are five such challenges and how they can be resolved.
1. Billing and Collections Mistakes
If a hospital or other healthcare establishment doesn’t have an effective billing process, it runs the risk of losing lots of money, from thousands to hundreds of millions of dollars per year. With high-deductible insurance plans becoming more common, patients are paying more money out of pocket. Or, if the patient is uninsured or underinsured, complications pop up because there is no guaranteed method of payment for the hospital beyond setting up a payment plan, which may or may not be paid in full. Additionally, if there is little price transparency and the bills patients receive are confusing, they are far less likely, once again, to pay in full.
These factors cause revenue cycle management problems to fall squarely onto providers’ shoulders, and providers risk losing business if they put too much pressure on their patients to pay for their care. Hospitals need to be able to collect the right information the first time at the point of service, while patients are still on the campus. Once they leave, it can be nigh impossible to find them again. Bad debt accrual is a risky but often inevitable result of ineffective billing. Without proper and streamlined collection procedure, hospitals may be unable to get maximum revenue and then end up operating with negative margins. To ensure financial stability, despite the dynamic world of revenue cycle management, hospitals need an efficient medical billing process manned by competent staff. At DECO, the first part of our process is to capture patient information so that we can be sure that it is accurate and complete, and then communicate with the healthcare organization. This helps lower the risk of errors and debt accrual.
2. Lack of Technology
This is an era of technological innovation. For hospitals and other healthcare organizations, this means providing effective electronic services. Having a poor or outdated IT system can do a lot of harm, because if no one understands how to use it correctly (even the hospital workers), chances are, costly mistakes will result. Such systems are needed to track claims and payments. If that information isn’t being handled properly, a lot of untracked or improperly tracked funds just end up being left behind or drifting through a computer network. Even having a quality patient portal and electronic bill pay with ease of access for the patient can make a world of difference. Having an effective computer system also requires that the healthcare organization have a team to monitor it and have staff that is properly educated on how to use it. Fortunately, DECO has a solution for this called DECOnet, a computer system that tracks patient information to make it easier on hospitals to keep necessary information in one convenient place.
3. Untrained Staff
The technology issue leads us to the next challenge, which is how to educate healthcare provider staff on how to best collect and process patient data. Patient data is traditionally collected upfront by hospital staff, but if the staff member processes it incorrectly in any number of ways, improper medical coding, billing, and insurance claim filing are often the result. These errors add up to costly hospital expenses and lot of bad debt. Furthermore, even if patient information is properly collected, staff members need to know how to track it and follow up on it. Unpaid and delinquent bills can easily get lost in the shuffle, even after only 60 to 90 days. DECO can provide assistance with this. Our revenue cycle management experts can intervene in the process to help make sure that patient data, claims and billing are all correctly and efficiently tracked, so that your healthcare organization can manage its finances well.
4. Lack of an Effective Financial Policy
Finances are what revenue cycle management is all about, so it makes sense that in order to keep that cycle running smoothly, a healthcare organization would need a concrete financial policy. Not having one of these can cause a whole host of problems for hospital staff, some of which have already been mentioned in this article. Having an effective financial policy adds not just a safety net for revenue cycle management, but also a codified process for how data, bills and insurance claims are to be handled. With such a policy, and with staff trained in its use, everyone can—often literally—end up on the same page. If a legal team has vetted the process, the healthcare organization can also gain peace of mind through legal protection. An effective financial policy can benefit patients, as well. Assuming the policy is communicated well with a patient, the patient then has adequate information, and therefore confidence, about what to expect in the billing and insurance claims process. In many cases, patients will fear the unknown of a healthcare financial policy and bills they don’t understand more than they will the fact of having to pay for their care. DECO’s revenue management and eligibility experts can help with this, as well. With our combined experience working with hospitals, government regulations and insurance policies, you can be confident that your finances are being handled properly.
5. Poor Monitoring of the Claims Process
Insurance claims are a tricky business. They are the result of multiple entities trying to figure out finances together, but with different goals. Therefore they can result in a lot of confusion and frustration for all parties concerned. This is why it’s imperative to be able to monitor the claims process from beginning to end. That way, providers and staff can be made aware of when and why a claim was denied, or can catch billing errors and coding issues. Automated alerts can help with this, as can a quality and easily understood IT system. This not only helps hospital revenue cycle management, but also makes sure that patients have the proper information for how they need to pay their bills. At DECO, our specialists have extensive experience dealing with the claims process. Since we usually take that part of the process out of the patients’ hands and stay in communication with our healthcare partners, you can be confident that you’re getting the right information and reports at the right times.
We’re Here to Help!
Your healthcare establishment doesn’t have to walk through these challenges alone! DECO’s revenue cycle management and eligibility experts are well qualified to guide you through the process of plugging the holes in your finances. We bridge the often wide gap between patients and providers and capture the information you need to be able to do business smoothly. Contact us if you have any questions or are in need of revenue cycle management assistance!