OmniMD

Revenue cycle management is at the core of any health care service provider’s sustained existence and growth. The revenue cycle management process keeps track of patients and the revenue side of their treatment. Healthcare providers may make use of standalone revenue cycle management software or incorporate it into their medical appointment software or plug it into the EHR system. Regardless, it plays a crucial role and covers various steps.

• Steps in the revenue management process
• The hospital revenue cycle management process covers:
• Pre-registration of a patient
• Registration
• Charge capture
• Claim submission
• Remittance processing
• Insurance follow up
• Patient collection

There is more by way of gathering data, analyzing it and deriving information that helps to identify weak spots and bottlenecks. The RCM system is complex and needs a thorough grasp of how it works for operators to derive the optimum benefit and overcome inherent challenges in the revenue cycle management. Advisory Board, hospitals can lose about $22 million without having an accurate and efficient RCM in place.

Training personnel

This is a key but often neglected area. Personnel who use the RCM software often have to learn it on their own and barely get past the essentials. Knowledge of medical coding as applicable to that region is crucial at the preregistration stage and in subsequent billing stages. This involves a learning curve for which time is required. Due to this some service providers may consider outsourcing to a revenue cycle management company. Coding a medical claim can take hours and needs knowledge that in-house personnel may lack and, therefore it may seem appropriate to hand over revenue cycle management process to expert revenue cycle management services. It also entails additional expenditure so, for the long term, it is best to introduce a degree of automation at the pre-registration stage and put in efforts to get personnel to undergo systematic training, possibly by revenue cycle management consultants. If there is no precise coding then the billing will not be accurate and it results in a loss as well as delays in reimbursement. With training your personnel can overcome bottlenecks of coding, set up the hospital’s chargemaster and capture charges in addition to being better placed to inform patients about all that is involved right before they register.

Technology implementation

Administrators and doctors in hospitals may not be familiar with how technologies work. Technology may be implemented in a piecemeal fashion with medical appointment software, EHR and revenue cycle management software working in parallel and in isolation. There is no connect between the data in each path and that poses challenges of streamlining operations and keeping tabs. It also becomes cumbersome for doctors or those in charge of RCM to refer to each and concatenate results leading to errors of commission and omission obviously to the financial detriment of the healthcare service. The smart thing to do is to engage expert revenue cycle management vendors or get revenue cycle management solution providers to integrate all disparate streams to be usable through a single interface. If usability improves it aids efficiency and personnel will make optimal use to enhance operations across the board from start to finish of the cycle.

The gaps addressed

Coding is just one part that could pose an immense challenge in the revenue cycle management process. There are others that affect smooth cash flow.

• It is vital for healthcare service providers to get their doctors accredited with insurance companies to avoid situations in which claims can be withheld on that ground. Overlooking this step can be a problem but it is easily taken care of with due attention right from the start when a doctor is going to be assigned to treat patients.
• The preregistration is a crucial step in which several key information can be missed such as insurance information and eligibility as well as financial expectations of the patient and payment modes as well. One needs to meticulously gather data at this stage.
• The registration step of the revenue cycle management process is another step that can face challenges due to inaccurate information and non-collection of advance payments and assigning insurance benefits as well as determining eligibility and amount.
• Missing charges is another challenge. Charge capture may be done through manual input of data or automated. Regardless, some charges such as ancillary services may be missed and if recovery is attempted at a later date then a refusal is likely. Revenue cycle management consultants could possibly help address this gap through measures like claims scrubbing technology to ensure coding is done right.
• Claims submitted to the insurance payer may not be in full conformity and this is also dependent on charge capture. Errors here may lead to refusal or delays. The solution is to vet each thoroughly and then track claims in real time to ensure only clean claims go through.

Accounts receivables, payments

It is often assumed that claims will be paid in full but that may not be the case. Insurance may pay less than expected and then it is for the healthcare provider to pursue the patient to pay the difference. Not paying attention to this could lead a mounting deficit. This deficiency can be overcome through the use of the right RCM system and by making the personnel aware about keeping track or, better, still, automating the system to send out a bill/reminder to patients fro such payments.

Data analytics

One must know how to analyze data derived from the revenue cycle management process, an area in which medical personnel may not be interested or capable of handling. It is essential that healthcare service providers know about key performance indicators and to keep watch over receivables as well as expenses and generate reports. Engaging revenue cycle management

consultants could bring your personnel up to speed in these areas. The RCM system generates and keeps on generating data that can be analyzed to derive useful information about revenue generation, reduce delays and address issues that affect processing. This is a challenge but training and familiarity through regular use of the revenue cycle management software by assigned personnel will deliver positive outcomes.

These are just a few challenges, mostly on the operational side but there will be others too such as software and hardware glitches from time to time. Retaining revenue cycle management consultants is one way to minimize and overcome challenges and ensure you get the most out of your investment in RCM software. Get in touch with OmniMD to resolve all such challenges and be prepared for future ones.

Change is constant. This applies to the field of patient data whether it is handled by individual doctors or by large hospitals and healthcare services providers across the country. From storing patient records in Excel sheets to database systems the world of patient data records has progressed to electronic health records. Even within this we have different types of electronic health record systems such as one hosted by individual physicians known as electronic medical records, remotely hosted electronic health record software and remote systems accessible to a large number of users.  

However, what distinguishes these existing electronic health record systems is that they are passive or historical, simply maintaining a record of the patient’s illnesses, diagnostics and treatments at one or more facilities. This is good but proves to be a stumbling block when there are major issues like a pandemic where other parameters come into play such as preventive and proactive measures to identify vulnerable populations, keep track of infected individuals, their recovery rate, their specific conditions and reactions to treatment and data to take steps to prevent spread. There are blocks such as high cost, excessive documentation and lack of user friendliness in currently existing EHR systems. Most of these focused more on the administrative and financial side with the medical side added on as an afterthought.  These systems also imposed additional work burden on personnel. The Covid pandemic worldwide brought out these deficiencies and paved the way to introduce changes to electronic health record systems for the future.  

It is time for a change to the electronic health record systems and the way they are implemented and used.  

In fact, according to EHR Intelligence, the use of EHR in July, 2020 increased by 2.06% compared to the pre-pandemic times. 

Future developments in electronic health record software could and should include various advancements as detailed below. 

Structural technical underpinnings

Future EHR software applications should have solid technical underpinnings to incorporate latest advances in IT technologies such as: 

Algorithms need to be incorporated into medical EHR software to combine various case conditions, interconnected health issues, treatments based on patients’ individual situations, flexibility for healthcare workers to step in as may be needed according to the situation but do it automatically and speedily with minimal human intervention.  

Such futuristic electronic health record ehr solutions would also have advanced decision support and workflow logic to remind team members through a variety of channels about patients, available plans and facilities for fast action.  

The future medical ehr software will be able to fluidly deliver analytics for individuals and for populations within specific geographic regions and to have predictive capabilities as regards spread of a disease.  

Intelligence at the core

As they stand current EHR software applications are focused on maintaining past data about patients, their activities and particularly the revenues side. Incorporation of intelligence into such EHR systems does not pose a big challenge given the voluminous amounts of data sets that can be used for machine learning to facilitate predictive capabilities. It could, for example, analyze variables such as whether a patient is following a treatment routine, their deviations and possible outcomes and suggest possible steps to remedy this kind of situation.  Importantly, futuristic electronic health record systems should be able to analyze and deliver suggestions to busy doctors so that they can put such suggestions into practice instead of wasting time in thinking about individual problems. Indirectly, analyzing patients in bulk who are infected with a specific disease could show up peculiar conditions that would be missed by most doctors treating individual patients. Real time big data analytics needs to become part of the overall electronic health record system to be used worldwide or countrywide, similar to the airlines reservation system in which all stake holders can get information in real time. This also has implications in disease detection, spread and preventative measures.  

The question of access

Though electronic health records are available for sharing by healthcare service providers, access still remains limited. The issue of accessibility needs to be addressed considering that 66% of users search for information on the internet and 88% of appointments is booked via phone or other digital means. Electronic health record systems can take a leaf out of how businesses manage their communications and manage customers by providing remote multi-channel access across various devices with fluid crossover from desktops to mobiles as and when needed, both for patients and doctors.  

Technologies to incorporate are natural language processing, voice recognition and IoT to further broaden the scope of accessibility.  

The question of accessibility also leads to standardization and uniformity of electronic health record systems as well as data protocols for glitch-free use and operation.  

Accessibility also raises issues of security that can be addressed using blockchain technology for validation, data security, claims, authentication and prevention of insurance frauds. 

Multiplicity of plans

Health care services would vastly improve and patients would benefit if future electronic health record software were to incorporate the facility to enable providers to prepare plans for various contingencies. 

Population health management

Instead of considering a single patient, the future electronic health record systems can help providers to set up plans for populations based on a set of parameters relating to disease, age, gender and economic drivers. Data can be gathered through various devices like smart watches and IoT devices and providers can take inputs to devise flexible plans.  

Health information exchange

Interoperability is a part of EHR but needs to be improved to give immediate access to any health care services provider, especially in cases of emergency.  

Training

The more sophisticated a medical health record solution becomes in the future the more complex it is likely to be and it will likely involve a learning curve. Service providers in the healthcare segment would work alongside solution providers to give training to bring users up to speed on 5G technologies, AI’s benefits, IoT and wearables and how to use the system to derive the maximum benefit.  After all, sophisticated electronic health record software is like a sophisticated car or aircraft—one must know how to use it or it will be practically of little use. It pays to join hands with the right vendor who considers all these aspects when you decide to go for medical ehr software. 

Enhance patient engagement, improve accessibility, and leverage standardized processes. Get medical EHR software now!