Healthcare is expensive. There’s no secret there. And while we could write a whole post on how much the industry is spending, we won’t. Instead let’s take a look at some data provided by the Centers for Medicare and Medicaid Services (CMS).
- In 2017, national health expenditure accounted for 17.9% of Gross Domestic Product. (Read: $3.5 trillion or $10,739 per person).
- Healthcare facilities in the United States currently stand to lose about $364 million in reimbursements.
- Health spending is projected to grow at an average rate of 5.5% each year to reach nearly $6 trillion by 2027.
Despite today’s costs and the anticipated forecast of additional spending, quality of care still suffers as providers struggle to manage expenses and make the right investments. But, the solution is in reach. Revenue cycle optimization can help you recoup every dollar spent on services rendered, so you can stop stressing about money and focus your attention on delivering care.
Improve care, lower costs: the all-governing mantra of healthcare.
But when healthcare organizations are not successfully recouping the money owed for care, both from patients and insurance companies, achieving either end of that mantra feels like a stretch, to say the least.
Why? Hospital costs are dwindling as operating costs continue to grow. (But you already knew that.)
What you didn’t know? You can break the cycle.
And here’s how.
After years of working with healthcare organizations of all shapes and sizes, we’ve gained invaluable insight into how the best and brightest are responding to a market seemingly designed to reduce the revenue you earn per patient.
3 Optimization Goals to Achieve Financial Viability
1. Track claims throughout their entire life cycle. Claim submission isn’t just a one-and-done process. It requires having the right data on hand at any and every given moment so you can see exactly where you went wrong (and change that error for next time).
Industry experts estimate that 90% of claim denials are preventable. Yet in 2017, health systems wrote off 90% more claim denials compared to the six years prior. That’s a $3.5 million loss over four years. Quit relying on inefficient processes to fill an important part of your revenue cycle.
Instead, make sure you have technology to support your staff.
Look for purpose-built intelligent automation that can pinpoint your issues in real-time, leading you to the next best action before you need it and allowing you to troubleshoot errors throughout the entire claim process to keep that claim moving and ensure you actually receive payment.
2. Reallocate jobs for specialization of staff. Requiring staff to handle the brunt of the repetitive, manual, and time-consuming work required for billing processes is a burdensome and costly task for an already overworked department. And while robots in healthcare won’t replace providers, bots embedded in software applications can be a key tool for reducing the burden of mundane, common tasks. (Read: claim status inquiry).
Staff should work where they excel. Sending categorized claims directly into work queues allows employees to become specialized in their work-lists, either by payer, plan type, or reason for denial. Do a celebration dance; your team of 100 now feels like 1,000.
Automating repetitive manual processes allows employees to actually have time to focus on meaningful conversations with patients. And since conversations create relationships, relationships create trust, and trust ensures that everyone is satisfied, patients feel engaged and supported, and you actually get paid.
3. Alleviate claim backlog. Many claims require manual intervention during at least one point of their life cycle, making an employee’s main challenge determining which claims need attention and when.
Rather than forcing staff to spend their limited time sorting through endless data, you need a logic engine that reviews, standardizes, and catalogues all payer reason codes on a claim to identify what is required within your HIS, give staff easy-to-understand claim updates, and reduce accounts per work-list.
Your system should know when it’s time to recheck a claim based on configurable days (like the routine amount of time a payer takes to adjudicate or the days since a particular status). Claims pending payment then fall off the work-list, and staff only work claims actually at risk of denial.
The Wrap Up
There is no magic bullet to solve your RCM problems. The revenue cycle has a lot of moving pieces. And while there are many technologies that will help, you must be able to see what works specifically for your organization and your goals.
Maximize technology where it makes sense to do so. Find the things that enhance staff’s ability to do their jobs well. Leverage data and insights to make sure you’re doing the most with the information you’re given. Put all those pieces together to create realistic goals that will help your revenue cycle processes run more smoothly. And then push to actually achieve those goals.