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Revenue cycle management (RCM) and access leaders face increasing work queues due to growing patient volumes, payer denials, and operational inefficiencies. Because of well-defined business rules in this area and structured data that systems exchange in conducting prior authorizations, RPA can significantly improve this process: Implementing a “bot” that performs the same tasks repetitively and without variation can help reduce error rates, so patients get the authorization they need quickly, and lower the likelihood of claim denials.
Hospitals compete for patients by hiring, acquiring and satisfying their physician order and referral base. In many markets, half or more of the community physicians remain independent instead of working for hospitals. Hospital executives who want to bring these independent physicians into the fold will offer them tools that make it cheaper, easier, faster and more convenient for these doctors to refer patients and order tests/procedures at their facilities. By offering these tools electronically through their electronic health records (EHRs), front-end revenue management and scheduling applications, hospitals can draw in more patients without having to hire or buy practices.
As the move to value-based care becomes inevitable, hospitals are learning that population health management can be a viable strategy for reducing costs and improving patient outcomes. The strategy is especially useful because patients with chronic conditions are usually high-risk, high-cost patients. In fact, chronic diseases are responsible for 86% of our nation’s total healthcare costs, according to the Centers for Disease Control and Prevention. Predictive algorithms are using artificial intelligence to identify chronic risk factors early, decrease preventable hospital readmissions and control increases in healthcare spending.
Machine learning can be used to avoid denials of claims by payers. Each year nearly 9% of claims are initially denied by payers, which means that for the average hospital almost $5 million in payments is at risk. However, 63% of denials can be recovered if the appropriate action is taken, but in order to capture these monies owed it costs about $118 per claim in administrative costs.
The best-proven method for improving your revenue cycle is to let practice management outsourcing companies handle administrative tasks. This lets you focus on patient care, and frees you from managerial roles. Practice management outsourcing companies can optimize and streamline your workflow to obtain the best results. It's like having a compliance manager in the house to resolve issues in data capture. Additionally, unnecessary tests can be reduced when hospitals implement an effective laboratory expert system. A report by the Veterans Health Administration found that a hospital branch saved more than $150,000 per year for two years after implementing such a system that helped reduce test volume by 11 percent.
Hospitals need to understand their own revenue cycle so they can identify opportunities and weaknesses. If hospital executives know how the hospital's revenue cycle works, then they can determine where to allocate funds and resources. Outsourcing can make a significant difference in the quality of your practice's work. It allows your staff to fine-tune their processes to higher standards and can help increase profitability. Implementing experienced professionals, the latest technology and other resources ensures that patients get a faster turnaround time without compromising HIPAA standards or privacy rights.
Revenue Cycle Management outsourcing companies such as Jorie Healthcare Partners can design a customized process for your practice, working in cost-effective packages that can save your practice time and money. This is possible with the help of advanced software, which they use to manage their services. At Jorie Healthcare Partners, the statistical key performance indicators help you look at each step of the practice objectively. With graphs and diagrammatic reports that are easy to understand, you can analyze gaps in workflow and give yourself tips on how to improve healthcare revenue cycle management for creating better income.