Revenue Cycle Management | Medical Billing Software for Healthcare

Category: Revenue cycle management

Tracking Key Hospital Revenue Cycle Metrics to Up Profitability

According to the Healthcare Financial Management Association (HFMA), revenue cycle refers to “all administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue.” Thus, a revenue cycle refers to the entire engagement of a patient with a hospital, starting from registration to the final payment of dues.

Revenue cycle management or RCM in healthcare utilizes billing software to manage different aspects of the revenue cycle such as patient records, claim management, payment and revenue generation. In short, RCM helps to keep track of the financial health of a healthcare institute. Apart from that, RCM also improves operational efficiency by integrating the healthcare data of patients with administrative details such as personal details of patients and information about their insurance providers.

In a nutshell, RCM allows hospitals to follow up on patient bills, and keep track of insurance claims to make sure payments are collected in a timely manner and denied claims are followed upon, saving a substantial amount of money for the hospital.

Reviewing Operational Data – It is possible to increase profits by measuring your RCM and determining the key performance indicators (KPI) for your business. Most hospitals have systems in place to capture several kinds of financial data. However, to boost profitability, hospitals must filter this data to zero down key performance indicators that can be tracked and measured against historical data to form the basis for operational improvement.

Three main KPIs that hospitals must develop to improve profitability are Accounts Receivable, Bad Debt and Claims.

Tracking Claims – Claim management KPIs to improve claim management can save hospitals a lot of time and money. Hospitals should aim for a high clean claim rate that indicates that a hospital is being paid faster without many errors. This can be achieved by capturing correct information at the outset to prevent silly mistakes. Thus, hospitals must ensure high efficiency in patient registration and appointment scheduling for improved claim management. The hospitals must also monitor their claim denial rate, using number of claims denied in a set period as a KPI. By investigating the reasons behind these denials, overall efficiency in claim management process can be affected.

Tracking Patient Access to Accounting Metrics – In order to improve denial rates, hospitals need to go back to the starting point to improve the process of capturing patient data and insurance data. To improve profitability, hospitals must develop patient access KPIs that would include pre-registration and insurance verification rates. By spending a few minutes extra during pre-registration, hospitals can save hours in verifying information and resubmitting claims later.

To develop patient access KPIs, hospitals may want to consider measuring rates for pre-registration and insurance verification. Insurance verification, a few days before the appointment, can help boost revenues in a big way as it allows the patients sufficient time to make self-payment arrangements in case the insurance cover is not valid. Thus, hospitals must try to maintain a high pre-registration rate and aim to verify insurance for most of the registered patients.

Point of service payments must also be looked into, as more patients than ever before are self-paying for their treatment. It is important to develop KPIs to measure point-of-service collection rates to ensure that the staff is collecting patient payments before they turn into bad debt.

Apart from ensuring that data is captured accurately at the pre-registration state, in order to improve RCM, management must set realistic revenue cycle goals on an annual basis, against which the performance of importance metrics can be measured. In addition to setting goals, the management must also have a bigger picture in mind it would like to achieve by meeting the set KPIs.

Top Healthcare Industry Trends and Challenges

Healthcare, much like other industries that are currently undergoing revolutionary changes, is fast-becoming an oasis of innovation. There is now a greater reliance on technology in tracking patients’ health. These range from wearable tracking devices to more improved patient databases. These improvements hope to enhance healthcare as a whole, and hope to shift everyone’s efforts to patient-centered care.

Nevertheless, there are still the usual hurdles of uncertain and rising medical costs. Focusing on technology has undoubtedly created challenges that innately come with it. These impacts are bound to be huge, to say the least, and equally revolutionary measures have to be done to overcome these hurdles. What is good is that measures are continuously being undertaken to address them.

With that said, the infographic we have designed below will give you a better view of the developments that healthcare in India has undergone in 2016. It’s sure to answer all your questions regarding the future of healthcare in this country.

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How To Provide A Quality Healthcare Management Services for Clients?

Quality management in healthcare is aimed at improving effectiveness of treatments and increasing the satisfaction level of clients with the medical services provided. Management of quality is focused on patients, as it is the patients’ satisfaction that is the ultimate judge of the level of healthcare services.

A healthcare system includes not only hospitals, but other components such as pharmacies and health clinics as well. A robust management of all these systems is required to ensure effectiveness of treatment and satisfaction for clients. Below are some elements crucial to providing quality healthcare management to clients.

Improving Quality of Care:

Improving quality of care and reducing costs is a key feature of the Affordable Care Act. In 2015, a new provision provides that physicians will be paid according to the quality of care they provide and not the volume they treat.

The WHO (World Health Organization) stresses on strict standards for management of quality of care. Quality of care in layman terms refers to providing the right healthcare service at the right time in the right manner. WHO defines it as a process for making strategic choices in health systems and further provides that improving quality of healthcare involves making improvements in six areas of healthcare:

  1. Delivering effective and tested treatments.
  2. Manner of delivery focused on optimal resource utilization.
  3. Right healthcare at the right time by professionals with requisite expertise.
  4. Treatment in line with patients’ preferences and local customs.
  5. Equitable healthcare irrespective of gender, location, race or status.
  6. Safe treatments minimizing risk to users.

Administrative Cost Reduction:

Administrative costs in the US account for up to 25% of healthcare costs, and a large percentage is wasteful expenditure according to several reports and studies.

Automation can help reduce administrative costs. Taking health plans online by explaining key benefits to members online, providing online enrollment and moving documents online can reduce costs by cutting down on labor intensive tasks. Electronic health records not only reduce paperwork and cut down administrative costs, but also reduce medical errors leading to quality healthcare for clients.

Professional Medical and Healthcare Teams:

Having professional medical and healthcare teams is central to quality healthcare management – healthcare teams comprise of allied healthcare professionals including pharmacists, physicians, dentists, nurses and other medical practitioners. Several areas report shortage of trained human resources to meet the health needs of growing population. Legislative measures to increase the number of healthcare professionals, especially in areas of shortage can help meet the goal of timely healthcare administered by professionals of right specialization. Telemedicine can be used to provide care in remote areas.

Telemedicine Adoption:

Telemedicine can be defined as exchange of medical information from one place to another using electronic media to improve a patient’s health condition. Use of live interactive videos for primary consultations, storing and forwarding diagnostic reports online and remote cardiac patient monitoring are all made possible by adoption of telemedicine. It provides several advantages by improving accessibility, reducing distance, reducing costs and offers better quality consultations especially in mental care and ICU telemedicine; thereby providing quality healthcare for patients giving them access to premier healthcare without traveling long distances.

Reducing Denial of Services:

While healthcare maybe considered a basic right, there have been many instances of denied healthcare due to lapses in medical insurance. In 2014, Affordable Care Act prohibited insurance companies from refusing to sell or renew policies based on an individual’s pre-existing conditions or gender. Strong implementation of this provision would reduce occurrences of denied medical services to patients, raising the quality of care nationwide.

Big Data: A Big Step Forward in Healthcare

We’ve been living in a digitized society for over a decade now. Everything we do is read, filtered and stored for posterity. Healthcare like every other industry has experienced this progress—whether pharmaceutical companies, hospitals, diagnostic centers or care homes, digitized medical records have been collected and stored in electronic databases over the years and have now been made easier to find, use and action as needed for the entire healthcare community.

Organizations now have insight into promising information/knowledge that was earlier not available to them. This existing big data can help find new treatment methods for specific conditions; solve the mystery of possible side effects, suddenly occurring symptoms, re-admissions, irritations, etc. The benefits as we know are plenty: improved patient care, reduced wait times, increased diagnostic speed, and higher patient satisfaction. The recent advent of new technologies has further improved the industry’s ability to work with this diverse, complex data.

Several innovative companies (both new and existing) are busy designing progressive applications and tools that will help healthcare stakeholders identify opportunities, ease concerns, and receive/give all-round care. According to a report published by McKinsey & Company, over 200 businesses created since 2010 are developing a diverse set of innovative tools to make better use of available healthcare information. This is just the beginning, as more and more innovative ideas get created and actioned, we can anticipate the birth of newer technologies that will reduce increasing healthcare costs, intensify security and protect patient privacy, complying with all Health Insurance Portability and Accountability Act (HIPAA) patient-confidentiality standards.

Governments globally are working towards making healthcare data (i.e., public data on patients, clinical trials, health insurance, medical advances, etc.) more transparent and accessible. For example: The 2009 American Open Government Directive along with the Department of Health and Human Services (HHS) under the Health Data Initiative (HDI), are starting to liberate data from agencies like the Centers for Medicare and Medicaid Services (CMS), the Food and Drug Administration (FDA), and the Centers for Disease Control (CDC) [Source: McKinsey & Company].

This new knowledge is creating a whole new mind-set. Patients, who once just followed Doctor’s orders, now take on a more intimate role in their treatment and decision-making. They have access to highly qualified professionals from across the world and can make lifestyle choices that can help them nullify their condition and/or prevent any further occurrences. Doctors can make real-time, evidence-based diagnosis, enabling quicker action and recovery.

Then there is predictive/prescriptive analytics and Genomics, where big data plays a very radical role. For example: When a patient comes to The ER with chest pain, the doctor’s often find it difficult to decide whether the patient needs to be admitted or can be sent home safely. With predictive algorithms, the patient’s saved history will aid the doctor’s judgment.

Here’s another example: It is likely that a patient’s medical records saved overtime, could on an ordinary visit to the hospital enable the doctor to spot a gene marker indicating Alzheimer’s. At one time, gene sequencing was an art known to a few experts, but with big data it would become as common as a regular blood test. This can help the doctor prescribe the right exercise, nutrition, medication, etc. in advance helping delay the symptoms or completely cure the disease.

Big Data is the future of healthcare. It will revolutionize medicine and increase life expectancy. Healthcare organizations that are open to new ideas; willing to ramp up their capabilities and treat innovation as the foundation of their brand, will be the ones progressing towards a better tomorrow, both for the caregivers as well as the patients.

MOBILE HEALTH TECHNOLOGY: AIDING BETTER DECISION MAKING

Today, comfort is the foremost concern and the key feature of care for all healthcare providers. Whether physical distress or emotional anxiety, different patients have different needs and caregivers must consider all factors before they make a decision.

Taking a medical decision can be overwhelming. Even, if it is a collaborative process where patient and physician make the decision together, the problems are often complex. The intensity is higher when the illness in question is life threatening. Also, the information available is either the patient’s side of the story or the result of multiple tests/examinations conducted. There is always a chance that the decision is incorrect.

According to a survey by PWC, one-third of the physicians said that they make decisions based on incomplete information for over 70% of their patients. They feel that patient compliance and assessing the limited information provided to them is the biggest obstacle in providing efficient care. According to an analysis by Health Research Institute, only half the physicians surveyed said that they access electronic medical records (EMRs) while visiting and treating patients. In fact, 88% of the physicians have indicated that they would like patients to be able to monitor their own health and vital statistics.

With the advent of sophisticated mobile health solutions, things in the medical world are changing for the better. Physicians and consumers alike are taking to characteristics such as convenience, cost-effectiveness, data accuracy, new ways to manage care and better health outcomes that these applications offer.

On the flip side, there is the fear of too much information. Considering that most of these apps record minute-to-minute movement of the patient, the data that is being collected is enormous. While taking a medical decision, the physician wants to see only the important aspects in the data, not every minute detail recorded. In fact, too much information can slow down the decision-making process, as there is that much more data to sort through before arriving at a diagnosis. This is where services provided by companies like Techindia come into play; they not only monitor and collect the data, but also analyze and sort through it in a short span of time making the physician’s work easier.

Physicians have already begun to adopt this new advancement. According to the PWC report, physicians believe that they can reduce office visits by upto 30%. 56% said these devices accelerate their decision-making process and 40% said that it decreases administrative time. Among the consumers, 20% use these devices to monitor fitness, 18% are very specific that they want their doctors to consistently monitor their health, while 40% are willing to pay a monthly fee for the service. Majority of the consumers have indicated satisfaction post the use of mobile health devices, clearly signifying that these gadgets offer valuable benefits to both patients and physicians.

Mobile health solutions are becoming increasingly sophisticated. It is imperative for caregivers to adopt these technologies to provide effective care and stay ahead of competition.

TOP 5 CRITERIA FOR CHOOSING THE BEST MEDICAL BILLING SERVICES

The decision to outsource billing services for your medical practice can have significant impact on your practice as well as revenue by freeing up more time for your patients and saving you the hassle of managing an internal billing department, if you are successful in choosing a professional and experienced billing service.

It can be an uphill task finding the right service provider to manage the revenues for your company. In this post, we’d share the top 5 criteria that can help you make the right choice.

Quality and Level of Services:

The basic services provided by a medical billing company include claim generation and submission, following up with carriers and preparing patient invoices and providing patient support.

Many companies also offer extras that can make your revenue collection system much more efficient.

  • Payment follow-up – Many billing companies follow up with patients who do not pay their bills on time, crucial to optimum revenue collection for your practice.
  • Denied claims – What are the procedures in place for following up on denied claims?
  • Practice Management – Many billing service providers report back on monthly basis on billing issues and provide insights and feedback for improved practice management.

Before selecting a medical billing service, you must agree on the level of services provided by the company for smooth functioning.

Use of Latest Technology

Latest medical billing software offer many advantages, provided trained staff is available to utilize the technology.

  1. What are the procedures in place for data backup, data recovery, patient information sharing and handling and security of data?
  2. Is the technology HIPAA compliant?
  3. How are the superbills and claims shared?
  4. Is the billing service in line with your company’s Electronic Health Record (EHS) system?
  5. Does the service provider have an integrated EHR system?

Quality of Billing Staff

Apart from the number of years the billing company has under its belt, the experience and expertise of the staff is also important.

The staff must be aware of your specialty-specific codes and procedures employed by your company as well as the carriers. Staff experienced with Medicaid or Medicare would definitely increase operational efficiency.

It is also worthwhile to check for AMBA (American Billing Medical Association) certification that tests the staff for knowledge on coding, medical terminology, HIPAA compliance and carriers.

Consider Pricing Options

Various price models are available and the choice ultimately depends on the size of your practice, average claim size and volume and the service package provided by the billing company.

  • Percentage model – In this model, the billing company will charge a percentage of the total collections. It is one of the most popular models as it provides incentive to the billing company on the basis of the revenue collected.
  • Fixed fee model – Here, the billing company will charge a fixed amount for each claim submitted by it. This can turn out to be a lesser expensive model, but isn’t very popular with service providers due to lack of incentives.
  • Partly fixed model – It is possible to have a flat fee model for certain carriers and percentage basis for others. The method is not very common, but can prove to be more cost effective than a purely percentage based model.

Check out the Company is Certified

The billing company must be HIPAA (Health Insurance Accountability and Portability Act) compliant and protect the patient’s personal information in alignment with your company standards.

The staff must also be AMBA certified. To maintain AMBA certification, 15 continuing education credits are required each year.

WE EXCEL WHERE OTHERS USUALLY FAIL

In an industry that is already marred with several business continuity challenges, high availability of resources is a critical success factor. At Techindia, resource availability is taken care by a highly competent team of executives, who work day and night to ensure business continuity for our global clients. Further, our world-class offshore centers, systems & connectivity and fool-proof processes ensure that our clients get only the best from us.

We have seen several service providers falter in this department. Most of our first customer touch-points have revolved around resource availability.

THIS WAY OR THAT, YOU WIN ALWAYS!

Whether you are in pursuit of maximizing resource costs, or looking to enhance patient engagement, or looking to adopt latest technology; we have answers for all your requirements. Customer satisfaction remains our prime focus. Our unbeatable value proposition of the healthcare domain and our operational capabilities combined with quality are bound to significantly improve the performance and profitability of your business.

Reach out to us and we will be happy to share demonstrable success stories. In the last decade+ of our operations, We have handled some of the largest healthcare providers in the US and have built long-standing relationships through sheer delivery and customer satisfaction. You could be one of them too!

UNBEATABLE DOMAIN KNOWLEDGE

At Techindia, we take immense pride in offering superior, dependable and cost-effective services covering the whole spectrum of processes for the demanding healthcare industry. Our workforce comes with rich domain expertise and robust compliance norms keeping customer trust as an underlying constant in the way we approach and deliver work.

Since 2002, Techindia has strived hard to drive new and continuously higher levels of efficiency for our clients in the health care industry. Continuous training and knowledge upgrade are essential elements of our process and quality is our mainstay.

REVENUE CYCLE MANAGEMENT

We understand that Medical Billing and Revenue Cycle Management (RCM) remain key business drivers for Healthcare providers. To this end, Techindia offers a comprehensive RCM outsourcing solution for IDTF’s, Hospitals and Physician groups that helps increase efficiency, betters patient-centric practices and drives profitability.

Whether your business needs a short-term customized RCM project or a long-term revenue cycle outsourcing, our RCM solutions offer credible results that are effectively able to merge people, processes, and technology. Our solutions are time-tested, robust and mature; we have several global customers who can testify our quality of service and delivery capability.

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