The healthcare industry in the United States is made of multiple layers of regulations, with a complex structure that has been subject to changes. Due to this, providing medical services and getting paid for the same has become quite a complicated process. Streamlining this process with a healthcare revenue cycle management platform can assist doctors as well as medical professionals to get paid fairly while reducing the cost of labour.
But as a healthcare professional, if you want to derive more revenue from the existing workflows, revenue cycle management analytics is what you need. The revenue cycle management analytics analyses the complete lifecycle of revenue right from the patient’s first appointment at the clinic to the final payment and follow-ups (if needed). Using RCM analytics brings out valuable information about the workflows in revenue generation. Also, tools like revenue cycle management analytics can help providers and healthcare executives understand exactly where they need to make amends to speed up their revenues.
Let us now talk about revenue cycle management analytics – its benefits and challenges in detail.
What are RCM Analytics?
The key for medical practices to increase profitability and gain long-term success is to manage the revenue cycles effectively. Healthcare organizations need to implement strategies and make effective decisions that help drive growth at the right time. This means that the financial implications of each operation within the medical practice need to be understood inside out and professionals need to gauge whether there is a room for improvement.
The systematic computational analysis of data related to a medical practice’s revenue cycle is coupled with the sequence of activities as the medical institute goes through to manage its financial performance. This process is defined as revenue cycle management analytics. Backend operations such as billing, payment processing, and revenue generation create RCM analytics. In short, revenue cycle management analytics or RCM analytics refers to software that provides insight into the revenue leakages and exhibits a scope for improving the revenue cycle management.
Data analytics can enable medical practitioners to take crucial financial decisions. By understanding what goes on in the back office, healthcare providers can examine important metrics before making decisions about their medical practice’s future. By implementing an efficient strategy, any healthcare institution can avoid setbacks, be assured that the operation management will run smoothly, and makes taking care of the patients easier.
What is Backend Medical Billing?
Backend billing is a complex process made up of multiple steps and involves various stakeholders. Backend medical billing starts with the first patient visit and includes everything from scheduling appointments, verifying insurance coverage, collecting payments, submitting claims to insurers, to processing reimbursements.
This ensures that healthcare providers are compensated properly for their services. All the components of the back-end revenue cycle must be efficiently and effectively managed to achieve this goal.
How Can Data Analytics Improve Revenue Management Analytics and Strategy?
Healthcare organizations integrate their IT and RCM systems to gain insights, speed, agility, and cost savings. Leveraging data analytics at every stage of RCM helps in optimizing financial performance which further streamlines medical billing operations simultaneously enhancing the patient experience.
Below we discuss three important benefits of incorporating data analytics in RCM strategy:
1. Better Financial Gains
When a hospital is backed with a data-driven approach, the caregivers can produce more accurate revenue forecasts which lets them allocate the resources better and anticipate cash flow fluctuations well in advance. Additionally, with the help of data analytics, the management can identify the patterns in claim denial which can further be used to produce strategies that increase claim approval rates and reduce denials in the future.
2. Improved Operational Efficiency
Apart from making financial performance better, data analytics can tremendously help in bringing operational efficacy. By identifying inefficiencies in the RCM, healthcare providers can take specific action to streamline the process – which would in turn save resources, time, and money. Over 40% of all remittances are still drafted on paper from payers, making EOBs and patient payments using checks, crucial data elements to a data-driven approach. Moreover, the data-driven approach to RCM can help in optimizing the allocation of resources, making sure that the staff is effectively deployed and the burden on the administrative department is minimized.
3. Enhanced Patient Experience
A data-driven RCM strategy by healthcare institutes can assist in fostering immense patient loyalty and satisfaction by significantly reducing the waiting time and facilitating better communication between patients and providers. This can, in turn, add to the long-term financial stability of healthcare providers.
Challenges of Implementing Data Analytics in RCM
Even though RCM analytics have multiple benefits, there is a fair share of challenges one cannot overlook. We list four things that must be considered while launching data backed by RCM analytics approach –
1. Privacy of Data
The most crucial of all, data privacy concerns have been a major concern for all healthcare providers. All medical institutes must make sure that they remain compliant with the Health Insurance Portability and Accountability Act (HIPAA). This includes safeguarding the data during storage and transmission as well as ensuring robust privacy policies to protect all the information pertaining to the patient.
2. Fostering a Data-driven Culture
Investing time and resources to train the staff to develop a culture that fosters a data-driven approach is necessary for healthcare providers. This implies that equipping the staff with the required skills is not enough. Care must be taken to nurture a mindset that strives for constant improvement. Promoting a culture that values data-driven decision-making helps healthcare providers to be sure that their RCM analytics strategy is in place and is responsive to changes.
3. Data Quality
To make the most of revenue cycle management analytics, healthcare providers must be equipped with reliable and accurate data. This makes implementing data validation processes a necessity which further establishes data governance protocols to ensure that the quality of data is always given utmost importance.
4. Choosing the Right Tools
To exploit the full potential of data in revenue cycle management analytics, healthcare providers should carefully select appropriate tools. While choosing data analytics tools, the following features must be considered.
• Ease of use
• Integration capabilities
While considering the features, bear in mind that these tools need to cater to the various requirements of the organization, making sure that technology is in tune with their specific requirements and goals.
Major Backend Billing Issues
One does not need to engage in healthcare revenue cycle management analytics to understand that medical billing forms are its backbone. A lot of providers experience major challenges in billing their patients and payers for the services provided by them in an accurate yet efficient manner. Let us now talk about a few major backend billing issues in detail –
1. Failure to Follow Up on Claims
You would be surprised if we told you that a lot of medical offices in the US fail to follow up on outstanding insurance claims – as a result, these institutions tend to leave a large chunk of money behind. The billing professionals must make follow-up calls to keep track of the status of the payment.
An efficient and effective insurance model can assist healthcare offices such as clinics, to recover overdue payments from different insurance carriers. This occurs when the accounts receivable follow-up comes into the picture. It must be noted that checking on insurance claims is a continuous process wherein the staff must monitor the aging reports proactively so that the ignored claims can be identified.
2. Inability to Build the Right Team
Do not underestimate the value of a team, especially in the case of medical billing specialists. If the billers and coders struggle to keep the billing accurate and have difficulty in communicating within your practice management system, the revenue cycle will suffer. Instead of leaving a team for an afterthought, hire an experienced team of medical billers who will support your practice and increase revenue while improving processes so that you can do a lot more with less. Consider getting support from a reputed revenue cycle management company by outsourcing your medical billing.
3. Insufficient Coding and Documentation
To create clean claims, you first need to streamline your medical billing specialists and start with accurate coding and documentation. Unfortunately, the care providers do not have much time during office visits and EHR issues are one of the most common causes of physician burnout. Overworked providers might miss putting relevant codes or supporting documents.
This problem can be addressed by training practice staff and redesigning the workflow. During the training, remember to assess and adjust coding as well as documentation processes carefully so that they fit seamlessly into everyday work.
How Does Jindal HC Assist in Generating Data-driven Outcomes and Accelerate Reimbursements?
Did you know that an efficient RCM has automated up to 70% of the back-end operations of the medical billing process? Jindal Healthcare’s RCM involves the collection and management of revenue from the backend office. The process begins right after the provider has catered to a patient upon his/her first visit, clinical documentation and coding responsibilities have been taken care of and the claim has been submitted. Our team comprises of:
• Experienced medical coders ensure that the billing is done correctly,
• Experienced payment handlers take care of the accounts receivable, and
• Denial management professionals make sure that any claim standing for over 50 days is resolved on priority.
We also have a dedicated A/R and denial management team responsible for follow-up calls regarding medical claims and identify with issues and appeals. They then follow up repeatedly. Getting medical claims and reimbursements addressed is a continuous process that requires improvement by providing feedback to the front-end processes.
To sum it up, the role of data in RCM analytics has emerged as a critical component in improving RCM strategies so that healthcare providers are able to enhance the financial performance of their company, streamline operations, and improve the patient experience. There is no denial to the fact that different challenges, such as data privacy, keeping up with data quality, fostering data-driven culture, and choosing the right tools, must be addressed but the potential benefits of introducing data analytics are immense. In an ever-changing landscape like this, tools like RCM analytics can empower healthcare providers to stay ahead of their competitors while ensuring long-term financial stability and quality patient care.