May 28, 2015
Health Insurance Portability and Accountability Act (HIPAA) now has stricter requirements for claims data submission. Government’s emphasis on eliminating health care frauds and abuses has apparently put the focus back on accurate medical billing. Real-time processing, consumer-centric healthcare & regulations and reimbursement structure reforms, in turn, have put increased pressure on healthcare providers to improve their revenue cycle management process. Here are some major factors in any provider's office that are both problems and solutions to incorporating changes in the existing revenue cycle process : -
While lack of skilled and qualified staff is an apparent hinderance in getting your revenue billing system and services in order, it also indicates in the direction of the only solution to the problem - you must have well-trained and experienced resources to handle the entire revenue cycle process. One option could be to develop your own qualified medical billing team in-house, which, of course, would involve a great deal of recurring expenditure. The other more viable option is to outsource your entire revenue cycle management to one of the dependable revenue billing services, who are continually updated with new regulatory changes.
Not only is the regulatory and compliance landscape changing, but the tools and technology necessary to provide streamlined revenue billing services are also changing. Insufficient IT resources can prove to be a major hinderance. According to a technological impact study conducted recently, 61% people find digital services an important factor while choosing a healthcare provider. The same study also reveals that online scheduling (41%), physician follow-ups (69%), online test and diagnosis results (33%) give patients great value. However, less than 33% of practitioners actually offer these services. The Wall Street Journal has also reported that more physicians require patients to verify their medical records for errors, and offering online reports can make the process efficient.
Policy and procedure -
Earlier approximately 40% of adults did not have insurance coverage due to factors like age, gender, health history or similar reasons. However, now with Affordable Health Care Act in place, all such adults will also be entitled to health insurance enrollment. As a result, a sharp rise in volume of complicated medical billing is impending beyond doubt. Coupled with the new complicated and confusing rules, there is bound to be an exponential rise in billing errors necessitating future re-submission of claims. As a result, your staff needs to be competent and well-versed with new procedures so as to face the costly illnesses in large volumes.
Benchmark Data -
As Peter Drucker quoted, “What gets measured gets managed”. Ensure to benchmark data against industry standards. External benchmarks can provide the greatest benefit in determining overall performance as it allows to compare against peer and identify’s areas to improve your revenue cycle.
In the present dynamic and highly demanding environment, you have the option to either invest in new technology and train your current staff, or alternatively you could hire the expertise and competence of revenue billing services whose core business is to remain adequate and up to date with the latest in medical insurance sector and revenue cycle management process.
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Revenue Cycle Management