The healthcare revenue cycle should always keep improving its service delivery to all its clients. Patient-facing is considered the front-end of the revenue cycle. The medical team at the front-end collect’s information from the clients, confirms the insurance cover they’re using and its eligibility. The staff also registers new patients.
On the other hand, back-end revenue cycle management comprises of claim management, denial management, medical billing, and the final state of the patient’s financial responsibility.
The two; front-end and back-end revenue cycle management teams perform distinct duties. If combined, the result is a complete healthcare payment system.
Healthcare providers and practices can maximize the healthcare revenue cycle by breaking down the front-end back-end tasks. The results would be a seamless revenue cycle that ensures quick, efficient medical bill reimbursement.
When the roles are segmented, knowledge gaps are created among the revenue cycle staff. They do not fully understand how a patient’s financial responsibility is calculated or what needs to be done to complete a claim process.
Hospitals and healthcare providers should aim to implement data-driven Medical Revenue Services. Such data reflects healthcare organization’s financial health, and the staff would effectively perform their tasks more accurately.
Collecting Client’s Financial Responsibility
Today, the health insurance market is dominated by high-deductible health insurance plans. This means that medical care providers are relying more on the clients to pay their medical expenses.
Consequently, an increasing number of patients fail to pay their medical bills fully in time. Some fail to pay up altogether. Late and underpaid patient’s financial obligation slows down healthcare revenue cycles. Thus, healthcare organizations run the risk of never being paid in full for the services to contact and collect such patient’s payments.
Therefore, healthcare organizations should begin by offering patients the financial estimate of the medical care extended to them before or at the point-of-service. Providers should employ software tools that can assess the payer’s historical data and then estimate the allowable expenses for specific procedures.
Healthcare facilities should also introduce credit-card-on-file services to improve point-of-service collection.
Opt for Prior Automated Authorizations and Eligibility
Many payers are choosing to increase prior approval and coverage eligibility requirements. This is intended to reduce unnecessary billing costs. If organizations continue using manual processes to confirm prior authorization and eligibility, then administrative costs will keep on ballooning. For instance, prior manual authorization can cost a provider ten times more than a prior electronic approval.
Despite these massive savings, electronic claim management adaption can be slow to implement.
Organizations can also optimize healthcare revenue cycles and other clinical processes with automated prior authorization. The staff would reduce the turn-around time it takes them to complete prior consent and over eligibility requirements. They would, therefore, focus their time on another high-priority task such as patient revenue collections.
Healthcare is constantly evolving from innovative care interventions and health information and technology to new payment structures and policies. Revenue cycle managers should ensure their healthcare facilities have a robust financial foundation. Such a base would help weather changes and adopt new service delivery methods.