Leading the Business of Healthcare
RCM Advisor

Quarter 2 2020 - Volume 25, ISSUE 2

HBMA RCM Advisor: The Journal of the Healthcare Business Management Association


Leveraging Automation for a Healthy Revenue Cycle

Implementing technology to automate the manual processes in billing and throughout the entire practice allows providers to make care delivery, reimbursements, collections, and overall operations more successful.

The field of healthcare collections is experiencing a lot of changes. Value-based care models shift reimbursement requirements, and the rising expenses of medical services are being shared by patients in the form of high deductibles and out-of-pocket costs, making collections challenging. Maintaining a healthy revenue cycle has become an evolving and difficult task for practices—especially for small- to medium-sized operations with fewer staff members.

The good news is that the industry challenges also present practices with new opportunities. Never before in clinical practice and revenue cycle management have technology solutions enabled so much functionality for staff and patients alike. Engaging with patients in new ways, marketing provider differentiators, processing claims efficiently, and collecting payments seamlessly are all ways to bolster practice revenue and growth. By implementing technology to automate the manual processes in billing as well as throughout the entire practice, providers can make care delivery, reimbursements, collections, and overall operations more successful.

Automation Is Key for Modern Practice
For a provider to achieve efficiency, there must be automation and integration of all workflow functions—clinical, administrative, and billing—within the practice. This is vital for allowing the billing process to start immediately following the encounter without double data entry. Understanding the practice’s billing specifics and typical workflows and applying technology to automate a large portion of them eases the burden on the practice.

Innovative technology solutions allow practices to manage their entire claim process in one place. This includes centralized billing for multiple providers and sites, including automated charge capture, claims scrubbing and editing, and addressing carrier-specific requirements prior to submission for best results.

Begin by Building a Patient-Friendly Culture
It’s a good idea to approach making any workflow improvements in the practice by considering first how they can help create a positive and engaging patient experience. Patient-centered practices can lower some of the business costs, generate increase in patient return rates, and lay the foundation for solid collections. Providers can start by creating a self-service culture with offerings that include patient portal functionality, e-statements, and the ability to pay online with a credit card. Practices should give patients an option to schedule visits online; remind them about appointments or lab work with texts and emails; and simplify the registration process, avoiding duplicate intake forms. Just as online retail businesses have simplified and streamlined the shopping and purchasing process for consumers, healthcare providers can make access easy and flexible for patients.

In making this a priority, practices demonstrate that they value their patients’ time. Patients also feel valued when providers reach out to them consistently and in a personalized way. By setting up automated communications for birthdays, holidays, or regular check-ins about progress or overall well-being, practices facilitate relationships with patients, remaining top of mind and making them feel connected. Such a friendly culture leads to a greater likelihood of patients engaging with the portal to execute specific functions, including balanced payments.

Simplify Payments With Technology
In the 2018 Trends in Healthcare Payments Report, 71% of surveyed patients wanted to get electronic statements from providers, even though only 17% said they received such statements; and 86% of consumers wanted to make all of their healthcare payments for all their different providers and care centers in one place.1

Moreover, the report revealed changes regarding insurance coverage and payments in recent years. High-deductible plans have led to higher patient bills; the Kaiser Family Foundation says that 85% of workers covered under employer plans had a deductible in 2018, up from 59% in 2008, and that the average deductible more than doubled from $735 to $1,573 during that time.1

“Slow paying” has become a coping strategy for patients: 42% of healthcare providers say it typically takes between one and two months to collect payment from a patient, while 35% say it takes them even longer. These lags remain costly. According to the Advisory Board Company, providers may be receiving as little as 18 to 34 cents for every dollar billed to those with high-deductible health plans due to administrative costs of follow-up.2

It’s vital that providers get paid before or immediately after services rendered. The likelihood of this increases as providers improve engagement with patients and offer the means to pay bills seamlessly and in ways that are convenient—through a portal, by setting up an automatic payment, and with credit card via phone, in addition to traditional in-office methods. By automating and integrating key patient-facing billing components in one place, practices give patients more transparency—and fewer surprises—about the costs of the services they’ve received. Moreover, providers can tailor strategies to work with patients on a payment plan or get a credit card on file, both of which increase the likelihood of timely payment.

The delay between rendering medical services and receiving the correct payment is also dependent, of course, on the quality of the claims submitted. Rejections and denials are prevalent for many practices, especially ones that rely solely on manual submissions. Human error has a major impact; some industry data shows that up to 42% of claims are coded incorrectly, and 19% lack appropriate documentation.3

Identifying and performing corrections for errors in billing codes, or claims scrubbing, generates cleaner claims, fewer denials, and improved payer communications. By getting it right from the outset—and enabling multiple types of edits to the claim before it is submitted—providers can be more efficient and find greater success with reimbursement. Automating this process through software makes the claims scrubbing and entire medical billing process smoother for all parties, helping providers to be reimbursed in a timely manner for the services they provided.

Get a Fuller Picture of Financial Operations
For healthcare providers looking to improve efficiency and generate more revenue, it’s important to garner full insights about the practice’s financial performance. With a deeper understanding of financial reporting, practices can eliminate billing leaks, unlock hidden revenue, and better inform a variety of business decisions. While a manual report analysis is better than no analysis at all, this burdensome task often generates inaccurate, incomplete, or outdated snapshots of operational reality.

If the practice’s reporting mechanism isn’t robust and integrated at the point of decision making, it’s not going to translate to substantial improvement in the billing cycle or overall practice operations. One simply can’t fix what one can’t identify.

The data insights required to aid in timely decision making are more impactful if the information is extracted and organized in a meaningful, customizable, and automated way. Advanced reporting tools ensure a practice not only survives but thrives during challenging economic times. Comprehensive, accurate reporting delivers the high-value information needed to identify financial billing problems, pinpoint solutions, discover new financial opportunities, and lead the way toward profitable change.

Consider the complexity of the revenue cycle: every detail matters, from the specific services performed (and for what indications, at which locations, and by whom), insurance payments and denials for particular codes, collection performance and timeliness, and the payer mix, to name a few. Having this degree of data depth and accuracy enables practices of any size to negotiate payer agreements as if they had the resources of a large hospital. They can find their ideal payer mix with a closer look at payment turnaround times and collection information.

Benefits of Practice-wide Integration
Revenue cycle management is a complex endeavor; there will always be a need for billing and management professionals to navigate transactions and optimize collections. Automation of the billing workflow and functions, though, can ease a lot of the practice’s burdens.

Integrated medical software solutions that specialize in billing, reporting, EHRs, and patient engagement can substantially free up staff resources for more patient-facing and mission-focused tasks. This is accomplished not just via a vendor’s industry expertise, but through the complete integration of clinical, administrative, billing and reporting functions, allowing various practice team members to maximize efficiency, make informed decisions and boost revenue.

Anthony Wade is a national sales manager of the AdvancedMD billing partner channel. He has been with AdvancedMD since 2015 and has helped serve AdvancedMD billing companies since joining the company. He is a customer advocate and puts tremendous focus on delivering innovative software solutions that improve patient care and provide patients with better access to healthcare while helping independent physicians create more efficient practices.

1 Part B News. 2018. Try high tech, high touch to urge slow-paying patients into the fast lane. Vol. 33, Issue 18, p. 1.
2 www.marketwatch.com/story/high-deductible-health-plans-are-hurting-health-care-profits-analysts-say-2016-02-17
3 https://oig.hhs.gov/oei/reports/oei-04-10-00181.pdf