As payment models shift, and the healthcare industry becomes increasingly complex, efficient revenue cycle management (RCM) practices are more important than ever. Practice management companies are at the forefront of this effort, helping healthcare organizations handle a myriad of administrative functions that involve patient engagement. Challenges often arise, particularly at the first patient encounter, related to incorrect or missing information. Practice management companies wanting to liberate themselves from these problems should look to automated RCM optimization tools, which offer a sophisticated way to streamline workflows and maximize revenue for healthcare customers.
Challenges in Traditional Practice Management Workflows
Sometime the smallest errors can lead to the biggest revenue losses — especially when they go undetected over time. Problems often begin at the healthcare provider’s front desk, where patient information is collected. Whether the patient is using an app or registering in person, outdated insurance information, illegible paperwork, or data entry errors can result in faulty demographic and payer information. Errors or gaps in patient demographics make it difficult or impossible to find coverage, send bills, and may lead to denied claims. That can cause a cascade of other issues, including reimbursement delays and extra administrative work to fix the errors.
Another big challenge relates to managing patient payments, which is undeniably complex. Less experienced staff may struggle to accurately determine co-pays or coinsurance amounts, and patients end up leaving the facility without paying. This can add financial strain for medical practices because the chances of collecting outstanding payments drop drastically after that chance for initial, immediate collection.
Errors and inexperience cost practice management companies and their customers time and money. Without good controls in place, revenue loss is inevitable. The good news is that automated RCM optimization technology that is designed to seamlessly integrate into any front- or back-end workflow can reverse the trend and capture more revenue without adding staff resources.
The Power of Automated RCM Optimization Tools
Automated RCM optimization technology can provide the controls that help practice management companies capture more revenue for their customers. Best-in-class solutions include AI-enhanced tools that replace time-consuming manual tasks, cutting down the workload and improving productivity for your staff — regardless of their experience level. These solutions can also optimize receivables by assisting with eligibility, verification of coverage, prior authorization (PA), and deductible monitoring — all of which can cause snags in the revenue cycle and delay or diminish reimbursement.
For example, the ZOLL® AR Boost® solution suite includes real-time tools that can be integrated into front-end eligibility, authorization, and patient financial inquiries to find, correct, and verify patient and payer information in seconds, enhancing your offerings to customers. Integrated capabilities include:
- Demographic verification — can help enhance core data for more than 82% of patient encounters, on average
- Insurance discovery — solves “coverage not found” errors and can identify active insurance, including retroactive Medicaid, for more than 40% of patients presenting as self-pay, on average
- Insurance verification — confirms eligibility and benefits, and assesses coverage, co-pays, deductibles, secondary coverage, and codes
- Deductible monitoring — monitors when the patient deductible has been met and shifts primary financial responsibility to payers
- Claim status checks — runs multiple claim status checks simultaneously to provide insight into how a claim is progressing and ensures visibility through resolution and payment
- Self-pay analysis — estimates patient’s propensity to pay and determines eligibility for charitable or prompt-pay discounts and payment plans to improve self-pay collection rates by more than 30%, on average
Embracing Automation for a Healthier Revenue Cycle
Incorporating automated RCM optimization tools into any stage of the practice management workflow is more than a matter of convenience — it is a strategic imperative to prevent leaving money on the table and keeping staff workloads manageable. By leveraging these tools, practice management companies can improve the accuracy of patient and payer information, streamline the billing and payment process, and ultimately improve financial performance for themselves and for their healthcare provider customers.