Transforming Revenue Cycle through Technology? (2024)

By Megan Zannetti, VP of Revenue Cycle, Graham Healthcare Group

The healthcare industry is constantly changing in ways that healthcare providers cannot control. Changes in payor billing requirements and payment models, along with fluctuations in patient demographics and health conditions can cause struggles for organizations with poor processes. Successful organizations must optimize their controllable procedures and create the bandwidth to address industry changes they simply cannot control. The use of technology to maintain financial stability is essential in this ever-changing industry.

Front end revenue cycle begins with patient registration and ends once payments are collected. Obtaining the correct insurance information and patient health profile upfront allows a company to develop the appropriate plan of care tailored for that specific individual. Many patients need health care right now and time is of the essence when verifying benefits and communicating patient financial responsibilities. Utilizing technology to verify eligibility automatically decreases the chance of human error, while providing faster results. Some insurance providers only authorize a certain level of care or visit count, depending on the patient’s health condition. Setting up system holds in the EMR will ensure that the company won’t provide unauthorized services that most likely will be uncollectible. A correct patient profile at the start of care sets the groundwork for the most efficient claim submission and collection process. Using online payment systems to collect known balances prior to the start of service significantly decreases the amount of uncollectible dollars at the end of care.

The automation of processes not only saves time, it reduces the chances of errors to allow for a steady stream of revenue and cash collections.

Healthcare revenue cycle can be challenging due to the length of time it may take to submit a claim for services provided. Many insurance providers require a significant amount of documentation to be completed before a claim can be submitted. In these instances, the provider must rely on the physician overseeing the care to complete and sign documentation. Since the remainder of the patient balance is contingent on the final claim submission, the lag in billing makes it difficult to collect a patient balance for a service that was provided long ago. Technology can play a key role in this process. By selecting a robust EMR that allows an agency to properly setup billing holds, eligible claims can be easily identified and sent out immediately when ready. Partnering with a vendor that assists with electronic document management is also essential in reducing the time it takes to receive these required documents. Creating this streamlined workflow to receive incoming documentation allows for a quicker review and attach process. From optical character recognition to utilizing a barcoding system, each document can be uniquely identified and attached to the correct patient record with a simple touch of a button. The time savings this creates from both a workload and claim submission perspective is vital.

Typewritten claims, paper billing, and mailing documents are something of the past. To maintain the optimal level of success, companies now utilize clearinghouses to submit claims electronically. A clearinghouse allows an agency to monitor the life of the claim from submission to payment. Receiving an automatic alert for a problem claim has now replaced the need for manual inquiries on payment status. This allows an agency to redistribute their resources from claim follow-up to claim submission. Denial management services are also key to success in an industry of varying payor requirements. These systems allow visibility into denied claims and suggestions on how to properly appeal the denial. Not only does this automation save time, but it also increases cash flow and collectability. To further complicate the billing process, many payors have different timely filing limits, so it is essential to automate submission reminders based on timely filing. This automation allows the billing team to prioritize time sensitive payors to ensure claims are sent before the deadline has passed. Without technology, it would be impossible to keep track of these different protocols and securing payment for services would be even more challenging.

Reporting and monitoring key performance indicators are an essential part of maintaining the integrity of the entire revenue cycle system. Many EMRS offer automated reporting that can be measured monthly to determine opportunities for improvement. These reports highlight anything from days to collect A/R, problem payors, and operational deficiencies that lead to collection issues. Investing in an EMR which presents these metrics at a glance allows an agency to proactively fix an issue before it becomes a financial loss. Agencies should continuously review the services offerings of vendor partnerships to ensure they are keeping up with the latest advances to address changes in the fast-paced health industry.

There is no doubt that technology has transformed the world of revenue cycle. Technology is no longer a choice within the health care industry; it’s a requirement. The automation of processes not only saves time, it reduces the chances of errors to allow for a steady stream of revenue and cash collections. Shorten the revenue cycle, decrease costs and increase revenue by transforming your revenue cycle through technology.