Revenue Cycle Management from a Healthcare CFO’s perspective
By ClearCycle Team

Healthcare organizations and businesses entrust their revenue cycles in the hands of their CFO. While organizations toil to provide the best patient care to their customers, an unwavering focus must also be maintained to empower the business side of the system. A Healthcare system is made up of diverse sub-systems that have a massive amount of data flow. All the different departments of the organization, like the claims systems, electronic record-keeping systems, cost accounting systems, insurance, and customer care systems, have an inter-flow of vast chunks of data daily.

However, more than two-thirds of healthcare organizations cannot utilize this data due to the lack of proper analytics tools, which could help them gain financial insights and make prudent decisions based on the findings.

It has become the prime priority of healthcare CFOs to plan and reduce costs. Lack of resources and the insufficiency to use data has hindered the process of effective financial planning.

Current Scenario of the Revenue Cycle of Healthcare Systems

Revenue cycles are necessary to bring in revenue into the healthcare system. An effective revenue cycle needs to be predictable. This can be hard as multiple processes are often a part of this cycle. These processes include medical services and their documentation, billing, preparation and submission of claims, and payments. As simple as it seems, frequent changes in the payment contracts, legislations, and inefficiently trained staff, coupled with an improper MIS or information system, can make the entire revenue cycle management extraordinarily complex and challenging to handle.

To stop this, most healthcare finance teams do not have sufficient tools for data capturing, reporting, and benchmarking. The availability of such tools could help them to study and analyze financial data and use it to reduce operational costs without jeopardizing health care quality.

Revenue Cycle Management: Keys to enhance efficiency

  1. Automation is the key: With the Internet of Things becoming a live reality, healthcare providers need to use a wide range of technologies to deliver innovative patient care. Even today, most organizations use paper-based methods. Companies could save billions of dollars in each cycle if they chose to automate claims management workflows. Automation of authorizations, claim submissions, and claim payment systems can massively reduce the administrative burden and go a long way to streamline revenue cycle workflows. It will also help to reduce labor costs and manual errors.
  2. Improvement in Front-end technology- Often, inaccurate information, such as missing or incorrect patient demographic data, can lead to common errors that lead to claim denials or underpayments. Manual front-end workflow systems can further build up errors. These issues can be prevented by automating the front-end workflows. Front-end processes like pre-authorizations, verification, and patient registration, can be based on agile technology. Such means could connect the front end with the back-end processes immediately.
  3. Improving budgeting and forecasting – The financial health of a healthcare system is dependent on budgeting and forecasting. Organizations that have longer annual budget cycles face challenges in terms of adaptability and productivity. Organizations should integrate value-based models that could readily make adjustments to the business strategies if there were fluctuations in the business environment.
  4. Automation of the Payment Systems– The type of healthcare payment model an organization adopts is crucial to determine its revenue. Even today, about 18% of healthcare companies are still using spreadsheets or on-site applications. A quick shift to technology is the need of the hour with electronic models for medical billing and payment collection.  The use of Cloud-based applications could massively improve budgeting, planning, and performance management.
  5. Adaptation to new trends– More and more Healthcare finance leaders realize the need to use rolling forecasting to meet new business demands and challenges. Such forecasts are flexible and help identify and adjust to market changes; It improves the timely allocation of resources, reduces labor costs, and creates a positive organizational experience. Organizations can look up to the replacement of their annual budget process with rolling forecasting.

Roadmap for Revenue Cycle Management or RCM

All CFOs aim to create the perfect Revenue Cycle Management plan to effectively identify, capture, and manage payment revenue based on the services provided. A successful RCM process is essential for a healthcare company to implement the maintenance strategy on all aspects of the cycle and maintain financial viability.

  1. Workflow Integration: Organizations need to invest in RCM technologies that can integrate well into established workflows and legacy systems. These technologies could assist in the creation of more agile processes based on Data, analytics, and automation. If technologies could link payers with the service providers without reliance on multiple phone calls and online search process, it will lead to quick cost estimates in real-time.
  2. It will, in turn, drastically reduce revenue leakage and create a better financial experience.
  3. Investment in Business Problem Analysis: This technique could be used to optimize the RCM of a company. Steps could be taken to automate portions of the revenue cycle based on AI and machine learning methods, robotic process automation, cloud computing, and Self-service Business Intelligence. The steps should be incremental and gradually lead to complete automation and optimization of the revenue cycles.
  4. Proper tracking of remote RC workers: Companies could apply tools, modules, or applications within RCM technology to track revenue cycle workers, whether working on-site or remote. Efficient tools to track productivity and work cycle time could significantly increase overall performance.
  5. Price Transparency: Health care companies could invest in self-service patient portals. Patients could use this platform to access their information in one place and use it to schedule appointments and enroll in payment plans. This step would initiate a transparent and real-time system to give price estimates and coverage.

Overall, optimization is the key to secure an efficient Revenue Cycle.  Optimized management of all resources, their usage, services, costs, and automation would help tremendously to build successful business outcomes. Taking one step at a time could build up with time to create the desired ideal system. Have a look at our offerings at Clearcycle to determine the best way to automate your reimbursements and claims processes, along with other operational processes.


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