In the contemporary digital age, the healthcare sector has initiated the employment of robotic process automation and artificial intelligence to administer its revenue cycle. The adoption of automated workflows is inducing fewer inaccuracies, amplified collections, and overall profitability. Nevertheless, despite these advancements, certain revenue cycle management (RCM) procedures, particularly in specialty healthcare, still encounter a gap.
For healthcare providers, efficient and sustainable RCM is of utmost importance. The management of the revenue cycle poses significant challenges for medical practices. As per a recent study, in 2020, the average primary care practice was anticipated to incur losses of nearly $68,000 per full-time physician owing to RCM impediments.
This article aims to scrutinize some of the most prominent revenue cycle management challenges faced by healthcare providers today.
- Increasing patient financial responsibility
One of the foremost predicaments encountered by healthcare providers today is the mounting financial burden imposed on patients. With the prevalence of high-deductible health plans, patients are now accountable for a greater share of their healthcare expenses. This can result in challenges related to collecting payments from patients and an elevated risk of non-payment.
To control this challenge, healthcare providers must devise proficient strategies for patient financial engagement that educate patients on their financial obligations and facilitate ease of payment. These strategies may entail the provision of unambiguous and transparent pricing information, offering payment schemes through a Patient Payment Agreement (PPA), and employing technology (like expEDIum Direct Pay, for example) to streamline payment processes.
- Complex billing and coding prerequisites
Another significant hurdle encountered by healthcare providers is the intricate billing and coding prerequisites of insurance companies and government payers. The procedures of medical billing and coding are multifaceted and necessitate meticulousness to ensure prompt and accurate payment. However, the regulations governing these procedures are continually evolving, rendering it challenging for providers to stay abreast.
To surmount this challenge, healthcare providers must invest in ongoing training and education for their billing and coding personnel and embrace sophisticated technology solutions that can automate and streamline the billing and coding process. Our team at iTech can help you address the revenue cycle impediments confronted by the healthcare industry by adhering to the highest ethical, legal, and practical business standards of the healthcare industry.
- Rising administrative costs
The weighty administrative burden of healthcare revenue cycle management is a considerable hurdle that healthcare providers face presently. The intricacy of the healthcare system is continually escalating, thereby resulting in soaring administrative expenses associated with managing the revenue cycle. This encompasses a spectrum of expenses, ranging from staffing and training to software and technology expenditures.
To address this challenge, healthcare providers must concentrate on enhancing process optimization and efficiency by harnessing technology, such as procuring medical billing software, to automate manual processes and alleviate the workload on administrative staff. This may comprise implementing electronic health records (EHRs) and practice management software, such as expEDIum, for instance, as well as introducing workflow automation tools.
- Regulatory compliance requirements
Healthcare providers confront an array of regulatory compliance obligations pertaining to revenue cycle management, which encompass HIPAA, HITECH, and the Affordable Care Act. Conforming to these regulations is imperative to prevent incurring costly sanctions and penalties, yet it can prove challenging to attain and sustain compliance.
To overcome this obstacle, healthcare providers must accord regulatory compliance top priority as a fundamental element of their revenue cycle management strategy. This may entail investing in staff compliance training and education, instituting policies and protocols to ensure compliance, and capitalizing on technology solutions that facilitate the automation and streamlining of compliance processes.
- Lack of interoperability and data integration
Finally, healthcare providers encounter a significant hurdle in achieving interoperability and data integration across diverse systems and platforms, which can impede the effective and efficient management of revenue cycle data, resulting in billing and payment delays and errors.
To handle this challenge, healthcare providers must allocate resources to data integration and interoperability solutions that facilitate seamless communication and data sharing between different systems. This may involve adopting standardized data formats (such as FHIR and HL7), utilizing APIs and secure web services, and investing in advanced analytics and reporting tools to manage healthcare revenue cycle data optimally.
Conclusion:
To conclude, healthcare providers grapple with a gamut of challenges in managing their revenue cycle effectively, ranging from augmented patient financial responsibility to intricate billing and coding requisites. To overcome these challenges, providers must prioritize process optimization, technology adoption, and staff education and training, as well as emphasize regulatory compliance and data integration to achieve a more streamlined and efficient revenue cycle management process.
Also, if you wish to maximize collections for efficient cash management, increased earnings, and enhanced patient engagement, please do get in touch with our experts here.
