8 Hospital Revenue Cycle Management Obstacles To Overcome (1) (1)

1. 8 Hospital Revenue Cycle Management Obstacles To Overcome Did you know that US hospitals offer $42.67 billion worth of uncompensated care to patients? Unfortunately, the number is on the rise. This clearly implies that healthcare organizations are bleeding revenue. What’s more, it also brings the inefficiency of hospital revenue cycle management into the limelight. If you are not already aware, revenue cycle management (RCM) plays a critical role in the healthcare industry. Wondering how? Let’s explain: Healthcare revenue cycle solutions outline an end-to-end process that manages the financial performance of hospitals and health systems. The outsourcing process includes the following: ● Accurate Documentation ● On-time collection of payments ● Ensuring efficient communication between patients, healthcare providers, and payers ● Seamless filing of claim reimbursements ● Focus on providing quality patient care. Failing to maintain an efficient revenue cycle leads to increased billing errors, loss of revenue, delay in reimbursements, and poor cash flow. Unfortunately, too many healthcare organizations today encounter challenges with smooth revenue cycle management owing to problems like unsettled communication chains and uncollected revenues. Hence, it is crucial for health systems and hospitals to improve their revenue cycles. What are the top 8 challenges of hospital revenue cycle management? Ever since the introduction of the Affordable Care Act, hospital revenue cycle management has constantly been evolving. As a result, professionals involved in the process encounter challenges such as billing errors, staying abreast with the amendment of policies, etc. Hence, understanding the challenges of hospital revenue cycle management is a need of the hour. The pain points include:

2. 1. Error in medical coding and collection Did you know that 140,000 and more codes are needed to settle reimbursements on claims? Also, a medical coder must have all necessary documents in place while filing a claim. The documents help coders to mention appropriate codes to process claims accurately. This clearly implies that hospitals and health systems must have a deeper understanding of the codes to create detailed and accurate clinical documentation. Every year, hospitals succumb to huge losses due to ineffective and wrongful coding practices. 2. Issues of non-compliance A well-planned revenue cycle management works according to the guidelines set by the Healthcare Information Portability and Accountability Act (HIPAA) of 1996. Federal law obligates hospitals to protect and secure sensitive patient information. Besides, the law instructs hospitals not to disclose patient information without a patient’s knowledge or consent. Issues of non-compliance lead to penalties and fraud charges. 3. No upgrades in technology It is 2023. Words like artificial intelligence, robotics, the Internet of Things, and big data analytics are no longer just concepts. It is time to update the old, dated IT system with enhanced technology to optimize healthcare revenue cycle solutions. In short, replacing the old legacy system and leveraging software, technology, and tools to stay up-to-date with revenue management trends is a need of the hour. 4. Lack of interoperability Interoperability is described as the ability of systems to communicate and exchange information without any glitches. The lack of information exchange between the different departments of the hospital results in the loss of time and increases healthcare expenses. Although hospitals are largely autonomous,

3. interoperability stands out as a huge challenge in the present time. It bars the open-sharing of data within the different departments of hospitals, making it even more difficult to integrate data with technology. 5. Patient-centred care A healthcare organization focuses on offering quality services to patients. Also, operating a hospital involves managing a zillion front-end and back-end chores, leaving no time for hospitals or health professionals to show empathy towards patients. Therefore, outsourcing healthcare revenue cycle solutions encourages maximum staff utilisation and increases productivity. 6. Shortage of trained employees The lack of training in healthcare workers is a huge setback for hospitals. From hospital billing and accurate coding to capturing patient data, chart documentation, and more, skills training in employees is mandatory to run operations in a hospital without any hassle. 7. Healthcare Analytics It is no secret that hospitals have multiple data points to evaluate. Using dated legacy tools prevents hospitals from exploring a goldmine of information. Implementing the right analytics helps hospitals optimize medical treatment, improve patient care, upgrade clinical decision support systems, stabilize cash flow, and streamline information. 8. Revenue Integrity Do you know what revenue integrity in healthcare stands for? It means clinical encounters between healthcare providers and patients are consistently converted into revenues. Even the simplest of mistakes, like incorrect codes, missed adding any modifiers can directly affect reimbursements for the services offered. In hospitals, capturing revenues is often challenging since fee formats, or entry charges are complicated and need to be more transparent. Also, bundled value- based healthcare protocols complicate the billing process, affecting revenues.

4. Thus, one of the foremost challenges in hospital is managing the hospital revenue cycle. This is why 54% of hospitals and health systems choose to outsource RCM to companies like 3Gen Consulting and offer better support to patients.