Revenue cycle management remains relatively elusive in the new healthcare landscape, as new regulations and reforms have led the industry to evolve and left many hospitals scrambling to keep their revenue strong in a value-based care reimbursement model. Today, technology platforms can play a role in assisting providers, payers, and consumers communicate and interact more efficiently, which will lead to a more durable revenue cycle management strategy. There are several key areas that revenue cycle managers could focus on to ensure their medical facility optimized their reimbursement.

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Financially clearing patients is becoming an important part of revenue
cycle management, as it helps hospitals and clinics avoid debt collection.
By Dr.Mahboob ali khan Phd PMP.
Revenue cycle management remains relatively elusive in the new healthcare
landscape, as new regulations and reforms have led the industry to evolve and
left many hospitals scrambling to keep their revenue strong in a value-based
care reimbursement model.
Today, technology platforms can play a role in assisting providers, payers, and
consumers communicate and interact more efficiently, which will lead to a more
durable revenue cycle management strategy. There are several key areas that
revenue cycle managers could focus on to ensure their medical facility
optimized their reimbursement.
“Generally speaking, in order to strengthen the revenue cycle management,
embracing technology within the revenue cycle is key,”I think, “Having the
platforms to seamlessly facilitate provider-payer interactions are really integral.
In many cases, it’s mostly about bad debt avoidance. With that in mind, there
are a few specific points. Some of these specific five might not be the most
glamourous, but certainly on the element of embracing technology, they are
critical.”
Updating patients on medical billing is key
One important step to take is to train staff on patient education early in the
process of treatment or medical care. This will ensure patients are not stupefied
when they receive a medical bill after discharge or a medical appointment.
“First and foremost, financially clearing patients early and consistently is
probably the number one element in mind. What that specifically means is that

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it’s trying to manage bad debt avoidance,”I reiterate. “A lot of what we see on
the front end or along the way materialize bad debt avoidance. By training staff
to collaborate with patients and to educate them early, it removes the surprises
when the bills come and that facilitates the payment component.”
Healthcare staff will need to be prepared to help estimate the costs of care for
each medical services so that patients are prepared to pay their bills.
Additionally, patients will need to be updated on any financial assistance
programs they may qualify for.
Patient consumerism trends are bringing greater expectation into cost
transparency across the healthcare field. Consumers are now requiring hospitals
and clinics to offer real cost information before agreeing to medical services,
which is a deviation from the past.
“This also includes things like estimating the costs and providing all the avenue
for sponsorship for those who can qualify,”I reiterate. “It’s becoming more
important as the way that consumerism continues to grow. It’s more than just
registration. It’s more than just point of service. Once again, it’s about bad debt
avoidance and financially clearing patients. That’s one element.”
Financially clearing patients is becoming an important part of revenue cycle
management, as it helps hospitals and clinics avoid debt collection. Cost
transparency is also an important part of improving patient communication.
“In terms of visibility, the visibility is critical. You can’t over-communicate
enough. A lot of consumers are expecting that visibility. They are shopping
around and managing their high-deductible plans and managing the cost of out-
of-pocket services. It’s important at the point of scheduling and communication
to leverage the internal staff and helps us focus on health accounts more likely
to collect.”
Greater staff investment and Internet-based medical billing
“Investing in staff is important,” he said. “Basically, providing all the
improvements along the way begins at the ground level. You have to have the
right pulse on your team. You have to understand the processes and provide
them with the right guidance whether that’s continuing education on the patient-
payer communications, whether it’s on data entry, whether it’s on payer rules,
or whether it’s on workflow tools that help to flag any process issues.”
“It’s important to continually educate the staff,”. “There’s just not enough
education. Even in meetings or morning huddles, in terms of allowing for open
communication of particular pinpoints - that’s all part of investing in the staff.”

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“There’s ultimately increased productivity and it helps to reward high
performers. Case in point, you might have the best processes in place but if
those who are in charge aren’t up to speed, you’re going to see job loss.”
Allowing patients more options such as online patient payment opportunities
will also lead to stronger revenue cycle management, as it would enable
consumers to pay their bills much more conveniently and quickly.
“Another element involves online payment capabilities,” he continued. “When
you think about the patient or the consumer, they want to have options. They
want to be able to conveniently pay. When you think about embracing
technology, there’s an evolution of what the revenue cycle has always done.
Five or six years ago, we were concerned with how to make the bills easier to
read and understand. Now the payment mechanisms have accelerated in terms
of text messaging or easy online payment capabilities.”
“There must be about 40,000 different healthcare apps and some of those apps
allow you to easily find a doctor. In order to anticipate how to make these
online payment capabilities put into the hands of the patient, we have to keep up
with that online payment technology,” I strongly suggest.
Utilize data analytics to obtain a clearer picture of the revenue cycle
Revenue cycle analytics and utilizing financial data is key to make the revenue
cycle more visible through charts or graphs. Dashboards and robust reporting
are advised for optimizing healthcare revenue cycle management.
“From a provider’s point of view, it begins with dashboards for reporting and
key performance indicators to monitor the transactions for payment denials and
revenue management,” he explained. “More importantly, using the analytics to
internally see whether our staff is focused on the things that they should focus
on. Ultimately, you can’t manage what you don’t measure.”
“We use analytics for predictability - whether that denial or that payment is
based upon a particular code, particular specialties, particular locations, or
particular accounts. What we see with analytics now is not just a rear view
mirror look but ultimately, when you think about machines, we have a specific
team of data scientists.”
In order to better manage the revenue cycle, measurements and data analytics
will be a necessity. KPI monitoring to track the health of the revenue cycle is
also important.

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Improving likelihood of patients paying their bills
One way to improve revenue cycle management is to target the patients with a
history of timely payments. This could also lower the cost burden on the
hospital or clinic. Propensity to pay tools are advised, as these technologies
could leverage credit scores and other financial data from a consumer’s
spending history.
“The fourth element is about leveraging patients propensity to pay. It ultimately
looks at increasing the likelihood for our staff to anticipate where we’re going
to have collection issues,” he mentioned. “Whether we’re targeting patients that
have a history of being frequent flyers, we’re going to need to be more timely in
terms of recognizing whether we need to allow them the right financial
counseling or whether we couple the predictability of payment around their
credit scores.”
“We see clients working with third-party payers. We see clients that work more
specifically with their own hospital-specific information. Ultimately, the idea is
to leverage credit scores and leverage our experience so that we identify upfront
where the hiccups and troubles will be and, ultimately, we embrace the best
practices that allow us to embrace technology,”I think.
View and update processes on a regular basis
For optimal revenue cycle management, it is important to revisit daily processes
to ensure everything is working smoothly. Even though there are many other
work-related performances taking place on a day-to-day basis and it may be
easier to address issues once they begin cropping up, it is safer to optimize
revenue cycle management through a preventive approach by checking on and
updating technological processes on a regular basis.
Cross-departmental task forces or strategy groups can help hospitals optimize
their revenue cycle management.If denial rates are too high, it is helpful to form
a recurring group to find the causes and determine a solution. Meetings will
need actionable items and goals to be more productive at strengthening the
revenue cycle.