With our personal health, we’d all rather prevent serious illness than be forced to seek treatment after we’re already sick.
The health of your business is no different.
Healthcare providers, from small family practices to large hospital systems, can’t effectively treat patients if their own processes and procedures are bloated, blocked, or otherwise unsound. In order to prevent this and ensure their financial health, organizations must practice solid healthcare revenue cycle management. The best practice for this is using healthcare revenue cycle software.
But before we talk about the software, let’s look at the process and its challenges.
What Is Healthcare Revenue Cycle Management?
Healthcare revenue cycle management is the process through which medical practices and equipment suppliers—such as home medical equipment and durable medical equipment (HME/DME) providers—collect payment for their services and products.
The cycle begins when patients make appointments for medical services or potential customers start looking to purchase medical equipment. The process continues through a number of additional steps, including but not limited to insurance eligibility verification, inventory checks, medical coding, assessment of billable charges, and collections.
This process has many moving parts and can easily get bogged down when not managed properly. Automation is key to streamlining these operations and navigating the healthcare revenue cycle. For this purpose, robust revenue cycle analytics software is worth its weight in medical-grade titanium.
Potential Pitfalls: Problems You Can Prevent by Using Revenue Cycle Analytics Software
There are infinite places where healthcare revenue cycle management can go awry. Let’s take a look at some of them.
Patient or Customer Account Creation
When an HME/DME customer makes contact, the supplier must be able to quickly verify the customer’s prescription and determine insurance coverage eligibility before starting an order. Verification involves checking electronic medical records. Doing this by hand might be possible for a small company, but the manual process still requires people-hours that you could spend on other tasks.
With the help of revenue cycle analytics software that includes hospital database integration, you can automate this process and make it entirely hands-off, freeing your employees to focus on other pursuits. Digitization also speeds up the processing time for the patient.
Revenue cycle analytics software also automates other checks, such as warehouse inventory verification, allowing you to determine supply and fill your customers’ orders faster. These benefits improve customer service, increase patient satisfaction and strengthen your brand reputation.
Claim Filing
Anyone who has run into problems with inaccurate billing or incorrectly filed claims as a patient knows the headaches these issues can cause. Such errors are just as time-consuming and hard to resolve on the business end — if not more so — because healthcare organizations send claims to both payers and insurance companies for reimbursement.
When these claims are not submitted correctly, HME/DME suppliers and other providers must start the arduous process of working with claim denials. This process also requires people-hours that would be more useful elsewhere. Furthermore, some rejected claims may slip through the cracks, costing your business money.
Managing Claim Denials
The issues we’ve discussed compound as claim denial rates climb. And they are climbing fast. In fact, hospital claim denial rates rose 23% from 2016 to 2020. In the HME/DME industry, the denial rate can go as high as 30%, especially if you’re talking about emerging businesses.
Problems ranging from improper ICD-10 coding to a missing signature on a patient’s charts can cause denials on a technical or clinical basis. In order to avoid endless claim-chasing that can bog down your processes and slow your productivity, healthcare organizations must develop procedures to resolve claim reimbursement quickly and effectively.
Without such procedures, healthcare providers can lose track of denied claims. When a claim gets rejected, the provider must determine the problem and rectify it before resubmitting. And when multiple denied claims come flooding back all at once, it’s much too easy to misplace one, only to find months later that payment is still outstanding.
Solving these problems requires proper automation of your healthcare revenue cycle management. Automated checks at the claim-filing stage can prevent providers from submitting improperly filled-out forms to payers.
Companies also benefit from automation that triggers reminders to deal with rejected claims they have not yet addressed. Reminders ensure that nothing slips through the cracks.
Avoiding Bottlenecks With Healthcare Revenue Cycle Software
NikoHealth is a modern revenue cycle analytics software that streamlines and automates your operations to reduce errors in your billing and collection process. With NikoHealth, you can:
- Speed up your processes by quickly verifying benefits coverage and patient account creation;
- Reduce claim denials by automating claims submissions;
- Reduce the number of missed denied claims by setting your system to remind you of non-addressed claims.
Ready to increase efficiency and reduce revenue loss due to poor claim management? Learn more about how NikoHealth can improve your company’s health today.
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