Long gone are the days where professional medical coders and billers pulled medical insurance claims off the typewriter and stuffed them in an envelope to be mailed for payment.
While technology has ushered in speed and efficiency to the revenue cycle management process, with it has come expanding complexities that providers and healthcare organizations must navigate to pursue payments for services rendered.
Developing streamlined workflows across broad processes with multiple integrated systems, coupled with payer billing requirement complexities, poses major challenges in the collections process. In addition to workflow and process challenges, a lack of usable comprehensive data and actionable insights makes pinpointing and resolving inefficiencies and financial leakage more difficult. How are providers and health organizations tackling these issues to promote patient care, ease the pursuit of payments, and gain more visibility into their operational and financial health?
Efficient workflows and processes are crucial to driving value for healthcare providers and health organizations. Providers and organizations are now leveraging a broad scope of integrated systems to deliver care to patients. Adoption of scheduling, verification/eligibility, electronic health records, charge capture, billing platforms, and financial management systems permeate through the healthcare landscape regardless of size or specialty. The Center for Medicare and Medicaid Services (CMS) has gone as far as to implement an incentive or penalty for the adoption or non-adoption of electronic documentation and patient care tracking measures.
A recurring theme for organizations is that many of these workflows and processes become segmented throughout numerous departments or vendors, often creating inefficiencies, as well as costly and complicated workflows impacting their bottom line.
Developing and implementing solid workflows will promote efficiencies, but providers and health organizations want to see the benefits within each segment. Implementing workflow metrics to ensure operations are running smoothly serves as a canary in the mine when they aren’t. Reconciling charges to appointments within 48 hours will ensure timely claim filing for 100% of appointments. Posting all payer payments/remits within 48 hours ensures all patient accounts are up to date and cash is being reconciled and booked numerous times per week. Denial follow-up within 10 days of receipt with an overturn rate of 95% or higher helps to maximize net collections in a timely manner. Among other workflow metrics, these are crucial areas to monitor for any lag, inventory build-up or staff training needs. When issues or lags arise in the billing, posting, or AR follow-up process, established workflows must be able to identify and address them as timely as possible.
With scalability, business continuity, and profitability in mind, providers and health organizations are looking to partners in the industry with the expertise and capabilities to provide guidance, develop and manage streamlined cost effective workflows, and compliment growth strategies.
As more systems are integrated and utilized within a health organization, standard/uniform data sets and the ability to analyze data across multiple platforms becomes a major hurdle. The aggregation and maintenance of data across a number of systems becomes a costly endeavor for providers and organizations. As a result, there has been an increased desire to partner with companies that have the capability to ingest large and diverse data sets and transform them into meaningful insights.
Custom reports and dashboards that help drive workflows, as well as trended financial information, are highly sought after to help identify inefficiencies and tell the financial story over time. These data insights are aimed at delivering the best level of care to patients, driving operational actions to improve efficiencies and reduce costs, and ultimately reduce time-to-cash to less than 45 days while achieving 95% or greater net collections.
One-size-fits-all solutions are not commonplace, as the operational landscape and technology utilization and capabilities differ from one organization to the next. Care providers and health organizations are looking for partners with diverse areas of expertise and flexibility to provide solutions to a broad range of challenges. Increased cash flow, reductions in outstanding accounts receivables, operational cost savings, and detailed insights through analytics are among the high-value strategies many health organizations are aiming for.
Kurt Anderson
SVP & GM, Payment Services EXL Health
Chase Riedel
Assistant Vice President of Business Solutions, Provider Services EXL Health
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