Healthcare Revenue Cycle Management Challenges

Healthcare Practices Face RCM Challenges

Healthcare providers of all shapes and sizes are struggling to fine-tune their revenue cycle to adapt to changes in the billing world. Constant changes to the healthcare system have brought about a variety of new challenges for providers and patients alike. This is particularly true for smaller practices who must rely less on large-sum payments from private or government insurance and more on payments received directly from patients.

There are any number of revenue cycle management mistakes that small practices face daily that keep them from realizing more bottom-line success.

3 Typical Revenue Cycle Management Challenges

1. Patient payments

   Among the most predictable revenue cycle challenges that small practice providers encounter in today’s healthcare market is the timely receipt of patient payments. With the upsurge in high-deductible plans, providers literally must fight to collect enough patient payments to help support their bottom line. Problem is patients no longer budget for medical expenses as they would with a lower deductive plan. The good news: this revenue cycle challenge is one that every small practice confronts.

2. Software

   Minus the appropriate software, providers are powerless to successfully file their claims, recognize coding errors and verify the output of their billing staff. An absence of first-rate medical billing software is an all too familiar revenue cycle challenge for small practices that results in their being incapable of boosting their billing workflow and results in a prohibitive number of claim denials and an ever-dwindling bottom line.

3. Resources

   Be it software, billing staff or a shortage of funds to put into action effective billing tools, an absence of resources is another widespread revenue cycle challenge, particularly for small practices. Without the proper tools, it’s virtually impossible to collect patient payments, particularly from those patients who have a history of non-payment. Billing resources take in such items as online payment processing, online bill viewing, patient education, credit card processing and other such valuable billing tools.

What can Healthcare Providers do to Overcome these Shortcomings?

While some of these revenue cycle challenges may seem impossible to conquer, there are always affordable solutions to help those small practices in need.

1. Online patient payments

   Need a simple solution to one of these revenue cycle challenges? Online patient payments are one such avenue in which small practices can encourage more frequent and on-time payments from their patients. A popular explanation that patients avoid payments is that they don’t know the safest and best way to do so. Online payment assimilation into their payment portal lets patients make a payment the instant they remember, via credit or debit card, making the complete process simpler and more manageable.

2. Find medical billing software that fits the exact needs of a practice

   True, employing top-notch billing software may appear like a hefty upfront venture, but the return is more than worthwhile. Medical billing software helps a small practice tackle and overcome several revenue cycle challenges that they routinely encounter. It helps realize additional patient payments by incorporating new payment choices, educating patients and empowering providers to improve their billing timetable. Medical billing software includes tools such as mass claims processing, insurance verification and payment reminders, plus 24/7 convenience. Contingent on the vendor, such software is usually reasonably priced, cloud-based and accepts as many user accounts / seats per practice requirements.

3. Patient engagement tools

   In addition to the engagement tools just mentioned, including online payment options, patient education tools and patient portal integration, there are any number of other such tools available, all dependent on how much you want to invest. One such tool are text/email payment reminders to help patients stay atop of their medical expenses. The more engaged a patient is in their medical billing the more likely they are to make on-time or even in-full payments.

Okay, in a perfect world, the art of providing healthcare would comprise nothing more than a sequence of one-on-one interactions between a physician and patient. The patient would pay for the services rendered, the physician would then use the payment to acquire supplies to maintain his/her practice and the cycle would begin again.

Of course, this picture is little more than an exceedingly simplified description of our current healthcare system that hasn’t existed for many years.

Today, offering medical care isn’t simply about the doctor-patient connection any longer. To the contrary, we now have government programs and insurance companies that let providers offer care to individuals who may not otherwise be able to afford it as well as to assure providers receive payment.

This, of course, has converted healthcare into the massive and quite complex system we have today.

So, what’s a small practice to do other than institute some of the suggestions mentioned above? Many such providers have turned to outsourcing their revenue cycle management process.

In the case of medical billing, a revenue cycle management company manages patient payments once patients go to self-pay. They offer an important step before patients get sent to collections, where it’s ever more doubtful the medical provider will ever get the full amount, if any amount at all.

Rather than having your in-house office staff making calls and sending letters to patients who owe money, the RCM vendor manages that for you. They also educate your patients as to their payment options. Insurance and patient payments are bewildering. Patients are besieged by not only the large amount they owe but also the numerous insurance codes and rules and perplexing reimbursement rules. That’s where a skilled medical billing company can help your patients work out their payments and how best to handle them.

Medwave boasts an experienced team of medical billing and credentialing professionals dedicated to serving your medical practice.