Top 6 Hospital Revenue Cycle Management Challenges

Data insights from hospital institutions suggest that a wide number of hospitals find it difficult for scaling and guaranteeing high revenue cycle performance. Hospitals usually have a large number of expenses and it is crucial for them that they receive patient payments from insurance companies, etc promptly. Thus hospital businesses must work comprehensively for meeting revenue requirements. To become financially successful, there’s of course a requirement for a stable and positive revenue cycle. Thus hospital institutions should attribute appropriate protocols for ensuring the optimal execution of the revenue cycle.

Hospitals face the financial crisis due to a series of reasons. The success of the revenue cycle is unattainable only because of certain roadblocks. Focusing on these movable roadblocks will enable hospital institutions in clearing the path for prosperity and gain. This task is paramount for hospitals for focusing on the various components related to revenue cycle ranging from schedules, patient registration, eligibility checks, upfront patient collection, claim-management to medical billing & patient collections.

Here are the Primary Six Challenges that Hospitals Encounter in Managing their Revenue Cycle.

1. Collection Cost

Currently, most of the patients are expected for paying directly for a large percentage of their health care costs. Hospitals, or any other medical provider, should collect payment from each patient whenever the service was rendered. This feature helps the hospital institutions very much economically. Many patients will have to trouble much for fitting the total cost of their medical bill. Especially during the lapse, the insurance coverage has either lapsed or doesn’t cover the majority of the bill. The hospital institutions are left to collect on the bill. The expense over resources for such collections is much high and affects into over the success of a revenue cycle. Hospitals if reduce patients’ medical bills along with offering discounts will guarantee prompt payment helping increase the percentage of payment at the point of service.

2. Claim Denials

Currently, medical claims data insights infer that health care providers are writing off a vast number of claim denials than in previous years. The available evidence reports that the trend will pursue because the success rate of health care provider appeals against claim denials are declining over the past few years. In the past years with medical claims denied mainly due to technical errors. With increasing reimbursement related to the value of the treatment given to the patient, and the number of denials related to technical errors has increased. Hospital businesses wish to recover large amounts, by ensuring improved clinical documentation used for making claims. They should also make insurance companies verify their service offerings are increasingly better health care. After all, they need to justify their claims.

3. Cash Flow Problems

These particular criteria of cash flow are critical for any medical organization, mainly due to the series of expenses. The business data insights from the last few years state some positive news. Cash flow is improving for health care providers. Medical revenue cycle experts claim that there are so many reasons for the effective improvement in cash flow which is widely regarded that writing off claim denials is effective in recouping losses.

4. Lack of Technology

Technological innovations are promising for hospitals and other healthcare organizations. In order to provide effective electronic services, poor or outdated IT systems must be updated for appropriate usage. Even if hospital workers do the task, they’re prone to making costly mistakes. Such technology systems are aimed at tracking claims and payments. Handling information properly, a technology backed workforce is needed for identifying a lot of untracked or uncover improperly tracked funds. A quality patient portal will enable electronic bill pay for smoothing the ease of access for the patients. An effective computer system also demands that the healthcare organization should develop an expert team for monitoring it and have skilled and properly educated staffs on how to use it. Ideal service providers will deliver a solution, a computer system for tracking patient information for making it easier for hospitals in keeping necessary information.

5. Untrained Staff

Educating healthcare provider staff over the best collection procedures and process patient data is quietly a great challenge. During traditional collection of patient data by hospital staff, there are chances for the staff member for processing it incorrectly. This will lead to improper medical coding, billing, and insurance claim filing. Adding up all these errors will lead to costly hospital expenses and in turn a whole lot of bad debt. Hospital Institutions when collecting patient information it should be properly collected. Staff members should know how to track it and follow up on it. Unpaid and delinquent bills will be neglected, even after only 60 to 90 days. Working with the revenue cycle management, service providers should intervene in the process of making sure efficient tracking of patient data, claims, and billing so that healthcare organizations can manage their finances well.

6. Lack of an Effective Financial Policy

Revenue cycle management is all about finances, so it makes sense for smoothly running the cycle. All healthcare organizations must be having a concrete financial policy. Without having an ideal will cause a whole host of problems for hospital staff. An effective financial policy will boost the safety net for revenue cycle management. The codified process over data, bills, and insurance claims should be handled. With ideal policies and trained staff, everyone can end up on the same page. With the legal team who’ve vetted the process, the healthcare organization can enjoy peace of mind with ample legal protection. Effective financial policies benefit patients, as well. Communicating well with patients, along with adequate information, and therefore gives confidence for professionals in the billing and insurance claims process.

Patients usually fear the unknown of healthcare financial policies and bills. Without a proper understanding of what they will the fact of having to pay for the treatment. An ideal service provider does effective revenue management and eligibility experts help with the same.

OURS GLOBAL’s cumulative experience of working side-by-side with hospitals, government regulations, and insurance policies, has earned as much confidence to handle finances properly. With ever-changing healthcare regulations combined with the evolving trend of revenue cycle management helps to keep up with a lot of variability’s in the healthcare industry. Staying current on updates to the Affordable Care Act (ACA), Medicaid, and other healthcare programs, healthcare providers should execute effective billing and tracking procedures. But to start with they must adapt to unstable times and needs. Without solid ground in these areas will deliver many challenges for hospital revenue cycle management. Even though errors are prone to happen, this will also hinder the hospital’s growth and service abilities. Hiring skilled, educated, and experienced professionals in this field or choosing to outsource their revenue cycle management requirements to an ideal service provider such as OURS GLOBAL will help hospitals in addressing common challenges for definitely delivering best in class patient treatment. Contact us right away.