5 Common Hospital RCM Pain Points – and How to Address Them
Jul 14, 2019
In the hospital setting, revenue cycle management is an integral – but complicated – component of ensuring an organization runs efficiently and effectively.
It's no secret that revenue cycle management is an integral – but complicated – component of ensuring an organization runs efficiently and effectively. But knowledge alone doesn't solve the RCM headaches healthcare decision-makers face every day.
The following are five pain points frequently experienced in hospital revenue cycle management – and solutions for addressing them before they take a toll on your organization's bottom line.
1. Errors in Billing and Collection
Though any hospital RCM department likely recognizes that preventing errors is a major challenge in billing and collection, they may underestimate the frequency of these mistakes. According to Becker's Hospital Review, professionals estimate that errors occur in as much as 80 percent of medical bills. And the Medical Billing Advocates of America reported that the number is on the rise.
"We are seeing a lot of the error types escalating, especially in the hospital area. We have such a complex billing system, that it leaves so much room for errors to occur on medical bills, and that is what we are seeing," Medical Billing Advocates of America founder and CEO Pat Palmer told the radio station New Jersey 101.5 FM.
When processes are rushed in an effort to ensure that the proper forms are submitted at the right time, revenue cycle performance can obviously take a hit. But it's not just about the bottom line. Errors in billing and collection can negatively impact the patient experience, hurting the hospital's reputation in an increasingly consumer-driven market where patients can choose to pursue care from a competitor.
2. Challenges Created by HIT
From robots that assist with surgeries to electronic health records that store patient information, tech is involved of a patient's episode of care – including financial arrangements. However, sometimes these advances also bring their fair share of challenges, particularly in terms of billing. Many organizations lack the HIT infrastructure to properly monitor and complete the RCM process effectively and efficiently, especially considering the diverse demands of ICD-10, interoperability requirements and other technical components of health IT present in hospital billing.
Furthermore, some hospitals don't have the staff they need to address the implantation and use of these HIT RCM processes. For example, according to the U.S. Bureau of Labor Statistics, demand for medical records and health information technicians is expected to rise
by 15 percent between 2014 and 2024. Over the last decade, hospitals have struggled to fill positions to meet this growing demand.
The RCM process takes involvement from a variety of key players in a healthcare system, which can create significant challenges.
3. Lack of Training and Resources
Even if an organization has the staff necessary to successfully navigate the RCM process, a great deal of training is required to ensure compliancy. However, given the high volume demands of the billing process, finding the time for proper training can be a challenge – not to mention expensive. Many hospitals consequently struggle to ensure that their RCM department receives the instruction, support and resources it needs to function efficiently and accurately.
4. Failure to Supervise Entire Claims Process
Hospital revenue cycle management isn't a short process, and failure to monitor the operation from beginning to end can result in costly errors. Mistakes can be made as early as when patient information is recorded during scheduling and registration, or later on when services are translated into ICD-10 codes and claims are sent to payers. When the whole process isn't monitored properly, it can be difficult – and time consuming – to determine where the problem occurred when a claim is denied.
5. Variety of Claims in RCM
There's no one-size-fits-all in medical billing. Patients have different types of procedures and insurance, and each of these situations has numerous requirements of their own. If an RCM department needs to address every type of claim, staff members may be forced to spend extra time working on those that are more complicated or otherwise out of the ordinary.
For instance, one of the more challenging components of the RCM process is auto insurance claims. These claims often occur with out-of-state residents, who may seek treatment in a different state than the one in which they're insured. Because different states have different requirements, the claims process can be complicated and confusing for hospital staff. Consequently, automotive claims – as well as workers' compensation billing – provide particular challenges that a hospital's RCM department may not be equipped to address.
While these pain points pose a significant challenge to hospitals, there is a revenue cycle management solution that can help all five: outsourcing components of the process. Whether you choose to find a vendor who can assist with a certain type of claim or the majority of the operation, seeking outside assistance can help your RCM department run more efficiently and avoid costly errors.
In 2016, healthcare vendors need the most efficient claims processing systems out there. By now, flexible, web-focused methods for important claims tasks are clearly the industry's path forward, and will play a major role in bridging the gap between patients and providers. A fast, digital claims method makes a direct link from implementation to delivery for workers' compensation and motor vehicle billing alike. Now is the time to invest in better revenue cycle management, with a focus on detail-driven, well-facilitated collection that breaks down barriers. Despite the growing pains involved with adopting any new technology, there are a couple of areas where smarter systems have already improved claims processing online. Direct accessibility With each new convenience, the future of healthcare looks more integrated. Data analytics harvests insights from seemingly unrelated details for fuller results. To make this innovation worthwhile, however, there needs to be a distinct pipeline between entities. "Data analytics harvests insight from seemingly unrelated details." Online healthcare portals are already addressing this need, providing direct communication through smart devices like phones and tablets. By bringing necessary information together in a simple, accessible source, these solutions set the stage for clean claims assembly. Shorter cycles Proper collection from the outset can reduce the amount of work hospitals have to do later if the claim is resubmitted, according to Gary Marlow, Vice President of Finance at Beverly Hospital and Addison Gilbert Hospital. "From a revenue cycle perspective, getting the most accurate information up front starts with patient scheduling and patient registration," Marlow told RevCycleIntelligence in 2015. "That provides the groundwork by which claims can be billed and collected in the most efficient and effective manner possible." The way information enters the claims process can impact how it gets managed. If technology, like artificial intelligence, is present at the beginning and guides the claims throughout, there's a consistent system handling the information the process to meet best practices. PROMEDICAL's benefits With our secure, efficient and comprehensive system, PROMEDICAL is staying ahead of the game. We're doing that by developing the following features: Communication: Users can choose from multiple languages with our online offerings. This allows you to customize your system to better reach patient populations and keep claims moving faster. Customization: If our proprietary options aren't currently meeting your needs, we can change them to do so based on feedback. Adapt to state fee schedules or language demands on a case by case basis. Encryption: A must for secure file exchange, PROMEDICAL ensures a secure file transfer process. Our process protects backup data equally strong as primary data, for efficient security across the board. Planning: Organizations also benefit when a set deadline is involved, putting clear limits on when submissions are set for review. Processing records requests within a preordained period of days helps managers know what to expect, and regular reports set up clear overviews of important statistics. Contact PROMEDICAL today to learn more about our healthcare revenue cycle solutions.
According to Pew Research, 15 percent of U.S. adults have used ridesharing services . Where does insurance enter the picture? Uber, Lyft and other ridesharing apps throw a proverbial wrench in hospitals' revenue cycle management operations. Billing is already a major pain point in hospitals – Black Book Research noted most facilities are outsourcing their RCM because in-house teams lack the resources to efficiently handle motor vehicle reimbursement. Ridesharing will only exacerbate the issue. For example, if a rider gets injured and has to go to the hospital, from which institution does the hospital receive reimbursement : The driver's insurance? The passenger's? Uber's? As Uber and Lyft are the most popular ridesharing apps, we'll focus on how these companies handle driver insurance. How do Lyft and Uber insure drivers? Lyft has three types of coverage within its insurance policies: Contingent Liability activates when a driver logs into the app and requests to accept rides – a state Lyft designates as "Driver mode." This coverage provides up to $100,000 per accident for bodily injury. Contingent Comprehensive and Collision kicks in when a driver has picked up a passenger. This coverage applies when a non-collision event damages the driver's vehicle. Uninsured/Underinsured Motorist applies when an at-fault driver who is uninsured or underinsured causes bodily injury to himself, his passengers or any third parties. The coverage provides $1 million per incident, and includes no deductible. For example, if a driver is injured in an accident at a time when he is not working for Lyft, his personal insurance will cover him (assuming he lives in a no-fault state, but that's another issue). However, when the driver activates Driver mode, Lyft's Contingent Liability will protect him even if he hasn't accepted a ride from a passenger. What if the driver's at fault? According to Rideshare Dashboard, Lyft's commercial insurance will cover all damages to third parties and the passenger, but the driver will have to cover his own medical expenses. That's when state laws dictate payment. In Massachusetts, for example, which also happens to be a no-fault state and requires all motor vehicle owners to possess auto insurance, the rider's personal auto insurance will cover the medical bills. Uber's insurance system is somewhat similar to Lyft's but possesses a few minor differences. For example, when an Uber driver is transporting a passenger, and another motorist causes an accident that results in bodily injury to the driver, the passenger and anyone else involved, Uber's UM/UMI will cover bodily injury of anyone in the rideshare vehicle.
With new, transformative technological advancements on the rise, it's no surprise that nearly every industry is feeling the impact of the digital age. From a healthcare provider's perspective, new resources can be used to revamp the current revenue cycle management processes you have in place. To reap the benefits of an optimized approach, you must be willing to take advantage of such emerging technological tools and resources, as stated by Chad Sandefur, Director and Healthcare Analyst at AArete. "Generally speaking, in order to strengthen the revenue cycle management, embracing technology within the revenue cycle is key," Sandefur shared with RevCycleIntelligence.com. "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." Let's take a closer look at the benefits of utilizing technology, plus some of the emerging resources your facility can use to revamp your current RCM processes: The benefits of an optimized approach By paying attention to the new digital advancements that can benefit your RCM, you can ultimately impact the workflow of your staff members while better streamlining services for consumers. Here are some of the advantages of an optimized approach: Reduced chance for human error – Human error is inevitable when handling large amounts of data. Management software can be used to keep track of patient data input and maintenance. Better opportunity for precise, automated data entry – Between appointment scheduling, data input and claims submission, employees have a lot of duties. Automated software can take care of some of these responsibilities, allowing staff members to better focus on a single task at a time. I ncreased cash flow – Claims management technology can expedite claims quickly and produce clean, accurate claims, ultimately increasing cash flow , as stated by Becker's Hospital Review. Optimizing your RCM approach can lead directly to a significant return on investment and improve the overall reputation of your billing department.
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