For a healthcare organization to succeed from a financial standpoint, revenue cycle management needs to be in place. It can be described as the management of claims, payment, and revenue production. To put it simply, it ensures that claims reimbursements are on time and accurate. Here is a brief overview of revenue cycle management and what it needs to be successful.
Where Are The Challenges?
The claims process for a patient begins the moment they contact a healthcare office to schedule an appointment. This is where a provider is going to be requesting necessary data such as insurance information for it to be later stored in the system. However, many feel that this process could use some restructuring because collecting correct information on a timely fashion can be challenging to say the least. A more straightforward approach may be to integrate billing information, patient accounting, and electronic health records together into one centralized location. However, keeping all this kind of information in one location does raise some red flags. There has been a drastic increase in data breaches for healthcare organizations. If someone were able to get into the system, they would have access to information like social security numbers, medical ID’s, and employment information.
Emphasis On Front-End
To get claims processed sufficiently, there needs to be a focus on the front end. In other words, the interaction between a patient interacts with a doctor, healthcare provider, or hospital. There needs to a more concise system for method for gathering insurance information and ensuring a patient’s eligibility.
Claim Denials Need Funding
Hospitals are in need of additional funding because of the recent spike in claim denials. Many of the regulations that were brought on by The Affordable Care Act were unclear and not specific enough. This is a problem because hospitals need to know exactly how to handle every patient’s situation, so they won’t have to worry about running into any major issues. We are seeing more payment claim audits being made on hospitals to ensure everything is being handled correctly. Also, many hospitals have no other choice but to request more funding because they are suffering financially from all of the Medicare appeals.
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