Getting More Out Of Revenue Cycle Management

Long been considered a back-office task, revenue cycle management (RCM) has become a hot topic for healthcare providers looking to leverage technology and a changing perception of the end-to-end patient experience in the age of health consumerism. Let’s examine how these changes are taking hold, and what RCM may look like in the future.

RCM can be best defined as a set of activities that typically happen at both the front-end and back-end of the patient process. The front-end includes activities such as patient data collection (or patient intake), insurance eligibility determination, and patient registration. The back-end typically includes claims management, billing, insurance denials, collections, and patient responsibility. The actual care event occurring in the middle is where most providers prefer to focus their energies, and bringing the two ends together is an ongoing struggle for most.

A McKinsey & Co. study found that healthcare providers only expect to collect 50-70% of the patient responsibility of a patient’s balance after a visit, and upwards of 70% said it takes at least a month to receive any payment. Those kinds of figures point to the importance of RCM as a strategic initiative, requiring planning, investment, and oversight, with real dollars at stake. By thinking about patients as consumers, providers can create a more seamless end-to-end experience that considers the financial implications of a care experience from the very beginning.

So what should providers do about this new reality? To combat losing revenue and cost inefficiencies, it has become a common practice for many to collect out-of-pocket fees upfront, thus allowing the provider to mitigate those risks downstream. Automation can also play an impactful role in the authorization of services. A 2016 CAQH index reported that manual authorizations cost providers $7.50, while electronic authorizations only $1.89. Both of these practices can have a real significance on the bottom line and will continue to become the standard. That said, clients of our Via solution are able to take changes to RCM a step further, and incorporate an expedited tool for claims reimbursements. Invisible to the end patient, Via allows the practitioner to get paid immediately, bringing DSO down to zero, without anything needing to change at the patient’s end. With integration already in place with leading EHR providers such as athenahealth and Kareo, getting started is easy. Contact Aquina Health today and find out how.