Overcoming Healthcare Revenue Cycle Management Challenges

Sep 25

Are your healthcare practice’s numbers not adding up? From appointment scheduling to insurance coverage to billing, your organization’s revenue cycle management (RCM) can be daunting.

Patient and clinical satisfaction and your reputation depend on effective RCM. The key to ensuring a steady cash flow and financial stability is to adopt a nimble approach to RCM that pairs the right technology with a nuanced understanding of the life of a patient account.

8 Common Concerns and Challenges of Healthcare RCM

Healthcare practices can lose up to 20% of yearly income due to flawed business processes. Are you experiencing this? Here's an overview of the revenue concerns and issues that directly impact your earnings:

Complex billing and coding issues: Navigating the complexity of medical billing and coding is a primary hurdle of RCM. Frequent errors when updating coding systems and payer requirements result in claim denials or delays and administrative burden.
Claim denials and rejections: Along with coding errors and payer-specific requirements, denied or rejected claims can also stem from missing information. A healthcare practice might not have the time, resources or expertise to handle these denials.
Patient payment challenges: Patients struggling with high deductible plans or understanding their financial responsibilities can delay or miss payments, which complicates practices’ collection efforts.
Regulatory compliance: Non-compliance with constantly evolving healthcare regulations can lead to legal issues, administrative and billing backlogs, and financial penalties.
Inefficiencies and administrative costs: Manual processes are prone to errors and can be time-consuming. These inefficient processes and outdated systems can increase administrative costs and waste time.
Potential security issues: Many providers are digitalizing the patient experience for the sake of convenience, quality and boosting revenue cycle. An unfortunate side effect is patient identities and data may be at greater risk.
Disconnects between medical and office staff: The senior physician of a medical practice must be an active participant in the revenue cycle process. Even with a competent office manager, miscommunications and disagreements with the physician about how to handle RCM can cause problems.
Patient or case mix documentation: Patient mix quantifies resources required to treat patients and the reimbursement due to healthcare providers. For example, the Centers for Medicare and Medicaid Services (CMS) use a case mix index (CMI) to determine reimbursement rates for cases. However, a reimbursement rate can be lower than a practice deserves if a case is not properly documented.

Outsourcing to a Top-Quality RCM Partner

Healthcare organizations can greatly benefit from outsourcing their RCM. Top-quality RCM partners can evaluate your practice’s roles and responsibilities, workflows, processes and communication and determine any pain points.

The right medical billing solutions and RCM provider can then address these concerns with education, auditing, data analysis and reporting, and the right software to streamline repetitive processes. In no time, you’ll be seeing improved cash flow and more opportunities to focus on delivering high-quality patient care.