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Healthy Revenue Cycle Management for 2017

There are multiple factors to be considered when ensuring you have a healthy RCM and your EHR plays a huge role. Don't let your system be the cause you're losing revenue this year.

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Maximizing RCM in Healthcare

If it’s been a while since you’ve taken a good hard look under the hood of your healthcare organization’s revenue cycle management (RCM), this year is a good time to assess how well it’s meeting your profitability needs. With uncompensated healthcare costs totaling $400 billion, the importance of EHR integration and accuracy within your RCM platform is at an all-time high to increase operational efficiency. A professional RCM consultant can help weigh in on how to dramatically cut your payment. 

Healthcare providers know that revenue cycle management is the process that manages claims processing, payment and revenue generation, and often entails the use of certain technologies to keep track of the claims process at every check point. But, according to the Healthcare Information and Management Systems Society (HIMSS), “RCM itself has lacked the interoperability, security, and the analytics necessary to understand how to improve the process through appropriate quality measures to keep up with changing reimbursement models and business needs.”

In other words, RCM has gotten the job done…but at what cost in lost revenue to healthcare providers?

Don’t make your revenue cycle sick by implementing EMR-EHR

Meeting Federal mandates and converting to electronic medical/health record systems (EMR-EHR) has taken years and cost healthcare organizations millions of dollars. But, you don’t have to make the situation more disruptive to your operations and finances by making unnecessary changes to your RCM systems. With planning and assistance, you can simply integrate EMR-EHR data into your RCM system from the start and make the migration an opportunity for technical, clinical, and financial improvements.

According to Revenue Cycle Insights, “Over the long-term, EHRs can be an important tool in better management of the revenue cycle.” That’s why it’s so critical to work closely with IT and finance partners to fully tap into the potential of any new systems and their capabilities. This can include other advantages, like substantially reducing claims denials and pressures from recent increases in patient liability, as well as the decreased ability of many individuals to pay even modest balances.

It’s clear that in this upcoming year robust revenue cycle performance and integration with EHR-EMR will play an increasingly important role in the financial health of providers, including hospitals, payors, medical practices, clinics, and a wide variety of other healthcare service providers.

2017 is a pivotal year for RCM challenges

Consumers demand more convenience and transparency. They want to know what they’re being charged for, what their insurance is paying for, and what they are left to pay out-of-pocket. They want more convenient ways to pay. Healthcare organizations are looking at longer collection cycles and more expensive revenue activity. These demands are new opportunities as well as significant challenges in 2017 for healthcare organizations involved in revenue cycle management.

Becker's Hospital Review recently enumerated some of the shifts that are having a significant effect on 2017’s RCM, including these trends:

  • Seventy percent of providers reported it takes one month or longer on average to collect payment from a patient.
  • Almost two-thirds of consumers expressed interest in using mobile payment systems, like Apple Pay, for healthcare bills. More than 75 percent of consumers choose to pay their household bills through online payment channels. Yet 87 percent of consumers said they received healthcare bills in the mail.
  • Revenue cycle management deal activity increased 47 percent in 2016 over the year prior. Revenue cycle deal value increased 314 percent over the same period.
  • Hospital and physician practices' profit margins are negatively impacted by highly manual revenue cycle processes. Sixty percent of providers and 86 percent of hospitals plan to automate time-intensive, error-prone manual backend processes by the third quarter of 2017.
  • Medical debt is the most common type of past-due bill for which consumers are contacted by collection agencies. About 59 percent of consumers contacted by a debt collection agency between December 2014 and March 2015 said it concerned a past-due medical payment.
  • For insured patients, McKinsey & Company estimated the rate of bad debt is increasing at well over 30 percent each year in some hospitals.

Add to these challenges, the concerns of integrating RCM and EMR-EHR systems to maximize functionality, claims processing, workflow, remittance management, and more…to take an okay RCM solution to one that’s great.

Is your organization ready?

This transitioning RCM landscape can readily leave your healthcare organization in the dust, not meeting consumers’ payment needs, not successfully integrating your RCM and electronic coding systems, and facing longer collection cycles, denied claims, and bad debt. That’s why it’s more important than ever before to have a healthy RCM system, with software and dashboards to set and monitor revenue goals.

To thrive in today’s health care environment and drive higher revenue cycle performance and greater financial health, you need robust revenue cycle management that excels from beginning to end. Plus, you need to do that while spending as little time, money, and energy on them as possible.

Conclusion

Blue Eagle Consulting can provide you with the experieinced software workflow resources for your RCM- related project. If you have a project coming up or a need that we can fill please call us at 1 (866) 981-1095 or email info@blueeagle-consulting.com