Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Practice Management News

The Benefits of a New Revenue Cycle Paradigm

Automating patient experiences, eliminating manual workflows, optimizing for outcomes, and reimagining payment methodologies will bring transformative benefits to the revenue cycle.

Healthcare revenue cycle

Sponsored by MD Clarity

- Technology is enabling patients and providers to connect in an unprecedented manner. The Internet, smartphones, wearables, and other technologies are allowing for instantaneous communication between providers and their patients and more types of data to leverage.

While patients are becoming more engaged with their care, healthcare revenue cycles can leverage the newfound connection to realize revenue cycle benefits.

Adapting the revenue cycle to the new connected world will be a significant transformation for most provider organizations. Investments in revenue cycle management technology have significantly lagged behind other projects, such as EHR implementations and other clinical technology upgrades. Further, the existing revenue cycle systems continue to be disconnected from the clinical workflows.

But integrating technology that engages patients with their clinical as well as financial experience will be vital to success in the changing healthcare landscape. Value-based care and consumerism in healthcare will require providers to break down the silos between care delivery and revenue cycle management to demonstrate value to payers, patients, and other stakeholders.

Implementing tools that enable seamless, constant communication between providers and their patients, and the ability to leverage this data will be vital to surviving in the new value-based environment.

Providers can prepare their revenue cycles for the new connected, value-based industry by automating the patient experience, eliminating manual functions, using technology to measure and predict outcomes, and entering dynamic reimbursement models.

Automating the patient experience

Patients are now acting more like payers, and increased financial responsibility is creating new demand for a connected financial experience.

Almost one-half of patients prefer electronic medical billing and payment whether through the patient portal or a web-based platform. Patients are also asking providers to keep their credit cards on file, have a provider website, and automate payment plans for medical bills.

However, few physician offices can meet those demands. Almost all organizations recently surveyed by HIMSS Analytics said they still rely on paper to bill patients, and only about 20 percent of providers in a separate study said they could store credit card information for their patients.

Automating the patient experience on the financial side is key to thriving in a connected world that prioritizes value. Providers must implement self-service technology that enables patients to schedule appointments from their phones, receive cost estimates prior to care delivery, and pay their bills online.

Not only will self-service technology enhance the patient experience, but the tools will also boost the bottom line. Patients are more likely to pay their medical bills in full when they can plan for care costs and control how they can pay for those costs whether it be upfront or through a payment plan.

READ MORE: 3 Key Strategies to Increase Healthcare Revenue Cycle Efficiency 

Eliminating manual processes

The revenue cycle is still primarily a manual process for providers as existing systems have failed to keep pace with changing demands. However, automating the patient experience from registration to account resolution will align providers with the connected healthcare world and significantly reduce their cost-to-collect.

Allowing patients to engage with the financial and clinical experience through convenient technology will eliminate costly revenue cycle processes.  The current paradigm revolves around manual data capture through phone calls and paper forms, endless task lists, and spreadsheet workarounds.  Technologies that can automatically capture patient information, verify its accuracy, and transform clinical notes into structured data for billing will eliminate the need for statements and collection agencies, generating significant ROI by shifting those responsibilities away from staff.

At the same time, the cost to collect from payers will also decrease. This automated capture of clean data from patients, including automated identification of plan-specific details that may impact billing, will prevent back-end claim denials, costly follow-up work, and frustrated patients left with an unexpected balance. Combined with technologies that automatically assign a projected reimbursement to every claim, staff can optimally focus on resolving issues with payers that yield the largest immediate financial benefit.

Using connected technology to measure, predict outcomes

Increased interaction with patients through technology will bring in volumes of useful new data. Wearables, mobile applications, and other convenient tools will allow patients to share health data with providers outside of the office.

The information can help providers develop a comprehensive, fluid electronic medical record, which enables providers to instantly uncover patterns, predict outcomes, and prescribe the most appropriate treatment based on real-time patient-reported data.

Providers typically wait weeks or even months for payers to analyze claims and clinical documentation data and send reports back on patient population outcomes. By the time providers receive the information, the state of a patient’s health may have already deteriorated, resulting in higher costs and utilization.

The analytics lag can jeopardize a provider’s success in value-based reimbursement models, which pay providers based on their care quality improvements and spending.

Connected analytics technology, however, enables providers to measure outcomes in real-time and automatically follow-up with patients to improve treatment. Using the tools, providers can also project how patient populations in their current state will impact spending and whether specific treatment plans can improve costs, utilization, and outcomes for that group.

READ MORE: Preparing Providers for Value-Based Care, Consumerism in Healthcare 

Implementing dynamic reimbursement models

Armed with real-time data on patient outcomes and costs, providers can quickly determine the value of their care using analytics tools. Demonstrating high-quality, low-cost care is a requirement for providers facing payers and patients demanding value.

Having the ability to identify a provider’s value proposition allows payers and patients to make cost-conscious decisions. Understanding a provider’s value is especially key for patients who are increasingly responsible for the costs of their care. Providers who can demonstrate that value have a competitive advantage.

That competitive advantage also extends to the payer space.

Traditionally, providers and payers negotiate contracts every year or every couple of years. But new connected analytics tools allow providers to demonstrate their value continually. The real-time ability to show payers a provider’s cost-effectiveness opens negotiations up to dynamic contracts that are regularly updated and allow for payers and employers to engage in more innovative arrangements.

Shifting away from the antiquated contract management model and engaging in creative, dynamic models will increase a provider’s competitive edge and it’s profitability.

How patients and providers communicate is transforming. Technology allows healthcare to be at anyone’s fingertips, and revenue cycles need to adjust to the new connected reality to thrive in a value-based paradigm.

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