Top 5 Revenue Management Issues Physicians May Face in 2017

February 03, 2017


According to a recent report from Zion Market Research, the global revenue cycle management market accounted for USD 23.40 billion in 2016 and is expected to reach around USD 43.80 billion by 2022, growing at a CAGR of around 11.0% between 2017 and 2022.

So what does this translate into for the physician? Does it bode good or bad? We are well aware that the RCM system tracks the financial record in the healthcare industry. When this cycle is well streamlined then the amount of denied claims using this well oiled system is reduced leading to more cash inflow for physicians. But are physicians and healthcare providers ready with such systems when deployed could make a big dent in the revenues held? The issues faced could be many, and streamlining just these 5 could help

  • Automation & IT systems:
    The time between providing service and receiving payment is reduced by interfacing various IT systems together. If each of the processes involved in the RCM cycle are not automated, then interfacing these systems would lead to more chaos. So the first priority is get automated and see that all systems can talk to each other- this ensures smooth and streamlined ways to manage the tracking and integration of both the clinical as well as business sides.
  • Delivery Model:
    From a Fee based system to a Value based system, has not been an easy road for physicians to adapt to. This change in payment and care delivery models has impacted Revenue Cycle Management (RCM). Further, the Centers for Medicare and Medicaid Services has pledged that it will tie at least 50 percent of all payments to quality, or value-based reimbursements by 2018
  • Coding compliance:
    There is an urgent need to review your coding compliance program. Make changes, train staff on the current coding practices and codes is very vital for a diligent billing and thus avoid medical audits for overbilling due to bad coding practices, which will also lead to high claim denials, despite your automation systems.
  • Clinical document:
    This is very significant for medical coding and billing purposes and has direct impact on the RCM cycle to help leverage financial stability. So once your coders are proficient, they ensure documentation compliance. Moreover, physicians who have no idea of administrative billing and hence pay no attention to documentation can be the reason for slow cash inflow.
  • Updated on Rules and regulations:
    Healthcare providers need to be not just aware but are also bound to ensure the various initiatives by the State and federal healthcare regulators - Centers for Medicare & Medicaid Services (CMS), the Office of Inspector General (OIG), the United States Department of Justice (DOJ), and various national and state accreditation bodies. The number of audit reports to be submitted electronically has increased twice-fold.

Only with great vigilance and diligence can physicians help manage to implement a well regulated Revenue Management Cycle process. Keep the above in mind and maybe all issues will be ironed out and thus impact your Revenue cycle in a profitable manner.


Category : Best Billing and Coding Practices