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Have you been hit by shrinking profits and operating margins? Healthcare providers and hospitals are witnessing up to a 48% increase in bad debt and nearly 100% decrease in revenue margins.
What is the solution? It’s time for providers to treat RCM operations as a profit center, subject to the same financial controls as any other part of their operation to function as efficiently as possible.
Here are 5 ways to level up your revenue cycle.
Start upstream with patient eligibility verification and prior authorization
Determining patient eligibility and coverage before service is the key to securing financial success for any healthcare provider. The focus of every patient interaction must be to collect the information needed to determine when and how revenue will be recovered for the services rendered to the patient. From verifying insurance coverage to qualifying patients for charitable funding, providing patients customized services will result in increased revenue and patient satisfaction.
Focus on all revenue streams
Typically, a practice receives payments from a health plan or payer, from patients and from third-party liability before writing off as bad debt. Each AR type demands a specific and customized AR solution.
Payer claims focus on timeliness, accuracy, follow-up and denial management
Patient self-pay requires multi-channel outreach that focusses on the patient experience
Third-party liability or workers’ compensation pivots on legal expertise and state-specific fee schedules
Customized workflow and technology must seamlessly manage the process by creating specific SOP guidelines, by making the right information available, and by setting oversight controls for efficient process flow and governance.
Every RCM operation must become digital by incorporating automation, artificial intelligence (AI) and blockchain solutions to accomplish business goals. In today’s healthcare landscape, digital RCM solutions augment human expertise and experience, tackling routine, manual processes and providing insight while humans perform complex, value-add activities. Automating even one task, such as verifying eligibility using robotic process automation (RPA), can generate substantial time and cost savings to reinvest in additional technology solutions.
Put data to work
Our process-mining solution improves the Revenue Cycle Management process, which generally covers medical coding, charge entry, claim submission, accounts receivable and appeals. Analytics and reporting optimize claims realization ratio, reduce denial rates and improve processing times. In addition, AR Prioritization and Prevention Prediction models visualize propensity-to-pay as per source, which increases revenue and helps gain an accurate, detailed and unbiased view of how your accounts receivable processes are performing.
Rely on a trusted partner
Cognizant is a leader in revenue cycle management, reducing days in AR by up to 30%. Our suite helps increase first-pass rate, reduce or eliminate manual interventions, decrease contract configuration time, handle most complex scenarios and support ongoing regulatory changes and payer requirements. We compliantly manage the entire life of a claim including verifying correct payers and coverage, ensuring proper billing, payment review and appealing any underpayments. Our utilization of clinical and legal expertise, data driven analytics and proprietary technology delivers optimal results for revenue accuracy, improving operating efficiencies and compliance while reducing days in AR.