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Healthcare Revenue Cycle Management Optimization is Crucial as In-Person Visits Increase

Believe it or not, while COVID-19 was arguably one of the worst problems faced by the U.S. healthcare system, it was just ONE of many. That’s right, there are a plethora of issues that have been hampering healthcare for years, causing patient safety incidents, lost revenue, and more. Unfortunately, these losses went through the roof due to COVID-19 – they were estimated to be around $323 billion in 2020. While the pandemic is slowly waning, things are going in the right direction as providers are opening their doors for in-person visits. To recover from the pandemic’s financial losses, healthcare revenue cycle management optimization must be one of the topmost priorities for health systems – let’s take a closer look at why it’s important and some strategies that can help with revenue cycle optimization.

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Revenue cycle management in healthcare facilities

Healthcare revenue cycle management might be quite complex, as it contains many intricate processes, but it is simple enough to understand.

Revenue cycle management, in a nutshell, is used by hospitals and health systems to keep track of the “revenue” they receive by treating patients. It has many steps, but RCM starts from the first interaction with the patient, for instance, appointment scheduling, and continues until caregivers receive the final payment. 

If broken down, revenue cycle of healthcare facilities usually contains 7 components:

  • Preregistration
  • Registration
  • Charge capture
  • Claim submission
  • Remittance processing
  • Insurance followup
  • Patient collections

As this list shows, the revenue cycle starts from the first interaction with the patient and ends with receiving the full amount for providing healthcare services to the patient.

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While it might seem simple, healthcare revenue cycle management is quite complicated and difficult, especially when it comes to collecting claims from the payers (insurance providers). 

Why optimizing RCM has never been more crucial

While it was always important for healthcare providers to improve RCM within their facilities, doing so now might ensure their survival and get them through this trying time. COVID-19 has drastically affected healthcare providers, and while some received bailouts in billions, others had to close their doors permanently. The rest of them are simply struggling through the financial losses, but as in-person visits are increasing, things look brighter for the caregivers, as long as they are implementing strategies that optimize RCM right from the start. 

That being said, let’s take a look at some of the strategies that can be employed to optimize healthcare revenue cycle management.

Strategies that enhance healthcare revenue cycle management

Examine the entire RCM process to identify gaps

While the age-old saying is “If it isn’t broke, don’t fix it”, rapidly evolving environments beg to differ. How do you know that it’s working out fine for you? Unless your denied claims are reduced to virtually zero, there’s always room for improvement. 

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Analyze the entire RCM process to see if there are addressable gaps that require improvement – even the smallest ones matter. Talk to patients, survey your RCM team, take a look at the current numbers, and determine where you want the numbers to be. If issues are not found, then great – the problem might not lie in RCM, but if issues exist, work on them. RCM is evolving rapidly, and with the changes brought about by COVID-19, introducing technology in almost every aspect of the service to improve efficiency and collaboration has become the new normal. And speaking of collaboration, let’s move to the next point. 

Improve collaboration between your front-end and back-end RCM teams

The traditional practice is that the front-end and back-end teams work towards the same goals, but separately. However, if they work more collaboratively then the entire process will become seamless and it will help optimize RCM as information is never lost or misinterpreted – helping to receive payments much faster and in greater numbers, improving the bottom line. 

Using solutions that guarantee accurate patient information

When it comes to RCM, one of the biggest impediments to its optimization is denied or rejected claims – most of which can be traced back to billing and coding errors. On the front-end, if the patients are misidentified or if inaccurate medical records are used, then there are bound to be inconsistencies that are picked up by the payers. These errors lead not only to billing errors and denied claims, but can also be detrimental to positive patient outcomes – affecting the bottom line and the goodwill towards the hospital. As a result, ensuring patient data integrity and accurate patient identification is a must – both of which can be done with RightPatient.

RightPatient is a tried and tested biometric patient ID platform that safely and accurately identifies patients using their faces. The patient only needs to look at the camera – the platform does the rest, making it an entirely contactless process, something that is crucial in the post-pandemic world.

Not only does RightPatient make identification faster and accurate, but it also ensures that accurate information is fed to the registered patients’ EHRs every time they opt for healthcare visits, reducing billing and coding inconsistencies and denied claims in the process.

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Claim Denials are Damaging More Than 30 Percent of Hospitals – Are You Stopping Them?

Claim denials have always been a problem – it is a fact that they have occurred in all kinds of health issues for many years. Nevertheless, it got pushed to the back of the line due to the COVID-19 as well as problems with IT in the healthcare field, efforts to get people vaccinated, etc.

Sadly, claim denials have gone up – they are happening much more often now. In fact, it’s reported they have gone up 20 percent in the last 5 years! That, along with other gloomy statistics, was announced in a recent study from Harmony Healthcare. With that out of the way, it’s time to look more closely at this situation and how revenue cycle management in healthcare operations can be improved by identifying patients correctly.

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A short update on claim denials

Claim denials, additionally called denied claims, are simply claims normally sent in by a healthcare supplier to the authorized payer, except for particular reasons, they were deemed “unpayable.” That occurs because of issues with coding and billing, mixing up medical records, missing filing deadlines, inadequate medical needs, or additional pertinent explanations.

So, here is what’s going on currently regarding denied claims.

Several disturbing statistics concerning denied claims

The COVID-19 pandemic triggered nearly everything to become worse, including denied claims. In fact, the earlier stated study showed a massive one-third of hospitals stated their denial rates were 10% or over. The study included more than 130 healthcare providers all over the United States and this rate of denial ranged between 6 and 13%. The accepted “danger zone” for denied claims is touted as 10%. 

This study likewise explained why hospital administrators think denied claims happen. Thirty-two percent said it was caused due to coding errors while twenty percent said the reason was front-end concerns. Nonetheless, both these issues may be based on mix-ups with medical records, which comes from patients being misidentified – we will speak more on that topic later. 

Whilst these revealed denied claim frequency, what’re the real issues denied claims cause?

The massive effect of denied claims

Denied claims are exceedingly expensive if faced – and may amount to around $4.9 million for the healthcare supplier. No matter how big or small a provider is, that is a huge portion of cash, and could even cause some hospitals to close.

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Understand, denied claims are not merely expensive on their own, FTEs or full-time equivalents must do their best to fix any coding errors so the successive claims won’t be refused or refuted. This means the FTEs aren’t doing their normal job, which slows down other work and causes the whole process to be ineffective. Altogether, these facts cause a major blow to the bottom line of these hospitals. 

As earlier stated, numerous denied claims are generated because of issues at the front end as well as coding mistakes, which happen a lot due to misidentifying patients.

The way denied claims and misidentifying patients are linked

This is very easy to figure out – it begins at the registration desk. The incorrect EHR gets noted with the patient, so, incorrect info is placed in the medical record. That may occur because of an error like an overlay or duplicate. If no one discovers the error before the treatment is concluded, the patient’s provider ends up sending the wrong claim info to the authorized payer. 

As the claim is being processed, the authorized payer closely inspects it and sees there are errors, thus the claim gets denied. Misidentifying patients causes coding errors and front-end problems. These issues can be averted if the patient is identified properly. 

RightPatient decreases claim denials, and goes beyond! 

RightPatient helps many healthcare facilities protect millions of their patients’ records. It’s the industry’s top touchless biometric patient identification platform. It works by identifying patients via facial recognition, thus averting overlays, duplicates, and mix-ups with medical records from the beginning. Therefore, this averts the claim from being denied, thus saving hospitals lots of money. It just may be the answer you need to reducing denied claims.

The benefits of RightPatient do not end there. Besides reducing denied claims, RightPatient improves patient safety, enhances healthcare outcomes, and ensures positive patient outcomes. 

Does your healthcare facility prevent denied claims efficiently?

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5 Strategies That Can Rebuild Revenue Cycle for Healthcare Facilities

As the pandemic wanes, at least for now, many businesses are rebuilding. The US healthcare sector is no exception, picking itself up and dusting itself down gingerly, preparing to welcome back patients and see an uptick in revenue again. Working on the revenue cycle for healthcare providers has never been more important.

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For some hospitals and departments, it’s already too late – the pandemic forced them to close. Others are hanging on, with staff returning from furlough and machinery being switched on and recalibrated for the first time in over a year. As more people are fully vaccinated, it becomes simpler to see patients in person again, which will lead to the increase in revenue the healthcare sector badly needs. However, it’s not all plain sailing. Providers could still lose over $120 billion this year, so it is vital to be careful with any attempts to ramp up income. The fewer denied claims there are, the better the bottom line will be. That being said, let’s take a look at some strategies that will help optimize the revenue cycle for healthcare providers.

5 strategies to enhance revenue cycle for healthcare providers

Check the existing revenue cycle management processes

The first option is to see whether any immediate improvements can be made to the existing system. This will be down to the back-end developers and IT specialists and will not be visible to patients. After that, it’s time to look at the patient-facing part of the cycle. Ensuring staff members are fully trained in customer service is a good place to start with optimizing revenue cycle management. That way, they will know what questions to ask when registering or checking in patients and how to check their insurance, treatment codes, and eligibility. They will know how long to allocate for different types of appointments and when to ask for immediate payment.

Use technology to your advantage

The easiest way to ensure that everything runs smoothly is by identifying patients accurately right from the start of the treatment process. This could be done using a patient identity verification platform such as RightPatient that eliminates the need for asking patients questions, patient record mix-ups, and more, reducing denied claims in the process.

That was just one example – optimizing the revenue cycle for healthcare providers is not difficult, it just needs a bit of help at times. Technology can be that hidden assistance.

Prompt, correct coding, and billing is key

An organization should not expect prompt payment if its internal processes are lax. Ensuring accurate coding and billing leads to lower chances of denied claims. Complete elimination of denied claims is impossible, because of some uncontrollable factors, but rigorous checking of coding will, in turn, generate accurate bills which are more likely to be agreed on the first time by the insurers.

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Utilize up-front collection

If possible, the up-front collection is the best way to optimize the revenue cycle for healthcare providers. This eliminates an entire step in the revenue collection process, as the bill does not need to be seen by accounts receivable at all. Instead, it lands on the collected revenue team’s side for processing. While this approach will not work for every patient, it can be an effective tool for immediate revenue generation.

Accurate patient identification underpins everything

Well-trained staff members are likely to know exactly how to identify a patient and take payment politely using a fast processing system, but the whole thing falls if the patient’s identity is incorrect on the system, or if changed details are input wrongly. Denied claims are annoying and time-consuming to rectify. There are ways in which technology can help minimize the chances of this happening, however. 

Getting the patient’s identity and billing details correct from the first interaction with them makes things so much smoother. It prevents duplicate medical records and overlays, for a start. If a patient only has one EHR, there is little to no chance that the insurer will find fault with the claim and so will settle the amount faster. Denied claims cost millions of dollars for every provider, often due to poor electronic health records and a lack of robust identity checks. Incorrect patient identification puts the patients at risk too.

One of the most innovative ways of ensuring accurate patient identification from the get-go is by using RightPatient. This touchless biometric patient identification platform is being used by several healthcare providers and has several benefits. It allows patients to identify themselves even in virtual consultations and during in-person visits, all they need to do is look at the camera, meaning that they don’t have to run the risk of others overhearing sensitive personal data when checking into a clinic. Nor do they have to use touchscreens or keypads to enter information – making it hygienic and safer than ever.

RightPatient is the solution that ensures accurate patient identification, reduces denied claims, duplicate medical records, and ensures fast billing.

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Improving Revenue Cycle in Healthcare Facilities in a Post-Pandemic World

The pandemic hasn’t only been difficult for the healthcare sector in terms of the number of patients treated and the severity of symptoms. For the American healthcare system, it meant a huge loss of revenue for everyday treatments, as every available resource pivoted to caring for the patients affected by COVID. Those facilities that couldn’t pivot were left with no option but to close and file for bankruptcy as their income was hit. Some managed to survive by furloughing their staff or redeploying them to care for the large number of seriously ill patients which COVID produced. As a result, revenue cycle in healthcare facilities took a huge hit.

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Some organizations, though, were luckier than others and were able to deploy remote triaging and virtual consultations by phone and video using the latest videoconferencing software – all of which can be bolstered by utilizing a touchless biometric patient identification platform such as RightPatient. This allowed them to continue to treat patients, and earn income, which softened the blow to their finances and helped both patients – who suffered no break in treatment – and staff – who were retained rather than furloughed.

Revenue cycle in healthcare facilities during the pandemic tanked, to put it mildly. Normal service dropped off a cliff and around three-quarters of healthcare providers had to put revenue cycle management in place, as well as ensuring employees could practice remotely and maintain effective social distancing when they did have to attend their workplace.

The return has started, remotely

Now that treatment cycles are returning to pre-pandemic levels in many places, the staff members are also returning to their usual roles. They are returning to treating their regular patients and making sure of their incoming revenue whilst minimizing the losses their facility may have suffered.

In order to optimize their abilities, staff members have learned how to use technology to help them assist patients remotely during the pandemic. This approach is likely to remain in place for those patients who are unable for any number of reasons to attend an in-person consultation.

One of the most popular ways to use tech in medicine is by organizing a remote consultation, by telephone or video call. This helps staff to find out quickly what ails their patient and can help them triage the patient more effectively, immediately. They can tell the caller at once whether they need to attend, offer an appointment if so and have all the notes from the call available when the patient comes in. If a referral is needed, the process can be started straight after the phone call, without waiting for an appointment or paperwork.

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Of course, processes still need to be followed. Not only does that enhance patient safety, but it also embeds the familiar for both patient and healthcare employee. Sorting out the paperwork before the patient arrives is of prime importance, and means everyone will know what is going to happen and what they can expect to be billed or paid for. Staff should check whether there is an authorization for the service under the patient’s insurance and what the patient’s responsibility is regarding this. Ensuring everyone is aware of charges and can reconcile them quickly is better for the provider’s income levels too. Being organized allows accurate expenditure planning, which helps everyone balance incoming revenue against outgoing expected payments.

Communication is key for improving revenue cycle in healthcare

Face-to-face, by email, text, shared app, or phone: no matter how teams communicate, it is best that they do. Patients with comorbidities or multiple conditions need dovetailed treatment, a patient pathway across several providers, and it is best to schedule appointments logically. Scheduling several simple appointments across nearby providers in one day is a possibility to reduce travel headaches for the patient, although it may make it an expensive time when the bills come due. That also relies on the finance and revenue cycle team knowing that they are to bill a particular insurance company for a defined treatment to a named patient on a given date. Communication makes all of these processes simpler and can help provide the necessary paper or electronic trails to ensure timely billing, and therefore prompt payment. The notification to finance should come from the clinical team, as they are treating the patient. They also know exactly which procedure was undertaken and how, so are best placed to ensure the billing is correct. 

An efficient billing cycle is one way to ensure reliable income, as everyone knows what is due to be paid, by whom, and when. It’s not just the medics and revenue billing team who have a part to play here either. Every healthcare professional who attends to the patient has a responsibility to produce documentation for their part in the patient’s care – all of this works towards optimizing revenue cycle management in healthcare facilities.

Technology can enhance revenue cycle in healthcare facilities

Accurate billing is essential when attempting to collect revenue. Billing the wrong patient, or a different insurance company, can delay payment and cause extra effort and paperwork for no gain. Correct patient identification at the start of the treatment cycle makes billing much simpler. A biometric touchless platform such as RightPatient can help eliminate patient misidentification and the nearly $5 million of denied claims which result.

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Hospitals Can Reduce Denied Claims By Preventing 6 Issues

The COVID-19 pandemic has caused arguably the worst financial strain the US healthcare system has ever experienced. While all healthcare systems around the world are facing similar challenges, the US is currently witnessing the highest number of cases in the world – over 10 million people! As the numbers continue to increase, so do the losses, and healthcare providers must reduce their costs to cope with these unprecedented numbers. That being said, reducing denied claims is more crucial than ever, as they cause caregivers to lose a significant portion of their revenue. Let’s take a look at denied claims, how they affect caregivers, and six errors caregivers must avoid to improve revenue cycle within their facilities, leading to improved bottom lines.

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What are denied claims?

While this is a common term heard within healthcare facilities, many still don’t understand how much loss can be incurred for any given healthcare provider. To put it into perspective, Change Healthcare stated that denied claims can cost around $4.9 million on average for any hospital. But what are claim denials?

Simply put, denied claims are those that are classified as unpayable by the payers (insurance companies) after they receive the process them. Claim denials often occur because there’s some form of error present within the claim that becomes apparent after processing. Issues such as missing information, sending the wrong information, and non-covered services are the common reasons why claims are denied. However, there’s another form known as a rejected claim.

When one or more issues are detected within a claim even before it was accepted or processed by the insurance company, it is classified as a rejected claim. Coding errors and mismatched procedures are the most likely causes that lead to such claims.

How do denied claims affect healthcare providers?

Claim denials are a massive pain point for healthcare providers as they decrease already razor-thin margins, significantly increase collection times and reimbursement, and consume valuable resources such as FTEs (full-time equivalent).

As we can see, claim denials significantly affect a hospital’s bottom line. Moreover, while 63% of claim denials can be recovered down the line, the administrative costs are a nightmare – $118 per claim. Thus, it’s better to avoid denied claims right from the beginning.

That being said, let’s take a look at the top six issues that lead to claims being denied.

6 issues to avoid that can help reduce denied claims

Absence of information

One of the most common mistakes that lead to claim denials is sending inadequate information to the insurance company. Even the smallest details such as date of surgery, date of onset, demographic information, etc., are liable to classify claims as unpayable.

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Issues with coding

Using an obsolete codebook or incorrect codes is a common mistake that leads to claim denials, as they cause revenue leakage.

Insufficient documentation occurs when there are missing elements required for the services billed, and it is extremely crucial to prevent them. Thus, immaculate documentation is critical to prevent legit claims from being converted to denied ones. If proper documentation is not present when coding and submitting claims, then insurance companies classify them as denied because they consider that the services were not performed.

Duplicate bills

Duplicate claims are quite common and are usually attributed to human errors. These occur when the revenue cycle staff forgets to remove a claim from the patient’s account after resubmitting the claim. However, as claims processing systems consist of tools that help detect duplicate ones, the systems flag and classify the anomalies as either suspect duplicates or exact duplicates. As the entire healthcare process is quite complex in nature, it might lead to original claims appearing as duplicate ones – resulting in a claim denial.

Simply preventing duplicate claims is not enough. Properly coding the billed service with required modifiers and documentation is crucial to help identify the bill as original and not as a duplicate.

Not filing claims at the right time

Various rules and regulations must be followed regarding claims and failing to do so will result in even legitimate claims being denied. For instance, the Affordable Care Act reduced the deadline window for submitting Medicare claims to 12 months from 15-27 months after the date of service.

Not verifying coverage eligibility for the services provided

Healthcare insurance is quite volatile, leading to constant changes. As a result, it is crucial to check eligibility every time services are provided to the patients. While this might seem like a tedious task, it will help save a significant amount of money down the line.

Whenever a patient comes in for healthcare services, it is essential to check whether the coverage is still in place (read: not terminated), the service provided is covered by the plan, and the cap has not yet been reached. However, a healthcare provider can cover its services using plans with a cap as long as it follows provided guidelines meticulously and provides the required documentation. 

Patient identification errors

One of the biggest problems that leads to claim denials is patient identification errors. Imagine this: if a patient is not accurately identified right from the start, the claim will be filed against the wrong medical record and the insurance company may ultimately classify it as denied. To ensure that claims are not denied and are processed smoothly, patient identification is a must. That’s where RightPatient can help.

RightPatient is a touchless biometric patient identification platform that locks patients’ records with their photos – protecting patent data. It can even remotely identify patients, making it ideal to be used across the care continuum and any touchpoint.

After scheduling an appointment, patients need to provide a personal photo and a photo of their driver’s license. RightPatient matches the photos to verify their identities, and when patients arrive at the hospital, all they need to do is look at the camera. The platform matches the saved photo with the live one, instantly eliminating any chances of the claims being denied.

Healthcare providers can reduce denied claims, optimize the revenue cycle, avoid duplicate medical records, improve healthcare outcomes, and even prevent medical identity theft with RightPatient – enhancing patient safety in the process.

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4 Strategies to Optimize Revenue Cycle in Healthcare and Mitigate Losses

The US healthcare system has been going through a rough patch for a number of years now. When one problem is solved, other critical issues arise. However, with all these preexisting issues, it is now facing its biggest challenge in decades: COVID-19. With patients postponing regular visits and elective procedures, COVID-19 has created a severe financial strain and plunged hospitals and health systems into unprecedented losses. While hospitals are having to cope with these losses by closing down emergency departments, laying off employees, and so on, they can significantly reduce costs by focusing on their revenue cycles. Let’s explore why revenue cycle in healthcare is crucial, some strategies to optimize it, and how positive patient identification can help significantly.

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Why is revenue cycle in healthcare important?

Revenue cycle management is one of the most crucial aspects of any given healthcare provider. In a nutshell, it is the series of events that starts when a patient schedules an appointment and ends when the provider receives payment and is reimbursed. Since it’s related to patient service revenue, it has a direct effect on any hospital’s bottom line. 

If a hospital’s revenue cycle is optimized, then it will face higher margins, and if not, it will face significant losses. Complications such as billing and coding errors, patient misidentification at the front-end, and miscommunication lead to denied claims and delayed payments. In the end, patient volume won’t matter if a hospital takes a long time to capture the revenue or faces denied claims. Thus, optimized revenue cycle in healthcare facilities is extremely important if hospitals want to continue to operate in the foreseeable future.

4 Strategies to optimize revenue cycle management

Improve front-end and back-end collaboration

The front-end consists of activities where the hospital’s staff members interact with the patient directly: patient information collection, appointment scheduling, eligibility, verifying insurance coverage, upfront patient collections, and registration of new patients are just a few examples.

The back-end, on the other hand, consists of medical billing, claims management, denials management, as well as the collection of final “patient financial responsibility”.

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Usually, when it comes to revenue cycle management, most healthcare providers have their front-end and back-end tasks separated. However, collaboration between the two can significantly improve revenue cycle management. Effective and seamless communication is the key, and if that can be facilitated between the front-end and back-end teams, then it will result in faster, more accurate, and improved collections.

Improve front-end activities

According to a recent webinar, half of denied claims incurred by hospitals can be traced back to front-end activities, with the top contributors being registration and eligibility issues. These ultimately cause issues at the back-end of the revenue cycle in healthcare facilities, and the caregivers are forced to allocate significant resources such as FTEs (full-time equivalents) to fix billing and coding errors. If the front-end issues are not addressed, then this will lead to an endless cycle of lower productivity and an unoptimized revenue cycle.

If the front-end processes can be improved by preventing common errors such as patient misidentification or missing patient information, then issues like claim denials, underpayments, and lower productivity of the FTEs can be vastly reduced. Automating the front-end workflow is just one step towards improvement – but more on that later.

Adopt revenue cycle automation 

Revenue cycle automation is becoming more popular within the healthcare space, and for good reason. It leads to a significant reduction in the pressure that is put on healthcare professionals, reduces avoidable errors, and streamlines the entire process. However, organizations have to be cautious in their search for an effective automation tool.

Identify patients accurately

The most prominent issues that cause revenue cycle inefficiencies are patient identification errors, duplicate medical records, and medical record mix-ups at the front-end. If the accurate medical record isn’t identified, then the subsequent processes will be riddled with errors, leading to denied claims. Hospitals lose a huge amount of money – around $4.9 million – due to denied claims, many of which can be traced back to patient identification errors. Thus, revenue cycle in healthcare can be optimized if patient misidentification, duplicates, and mix-ups can be eliminated. This is exactly what RightPatient does.

RightPatient is a touchless patient identification platform that is used by several healthcare providers. It uses the patients’ photos to verify their identities, eliminating misidentification, avoiding duplicates, and preventing mix-ups at the front-end.

New patients need to take a photo during registration, locking their medical records with it. Enrolled patients only need to look at the camera – the platform identifies the patients accurately by matching the photos and provides the appropriate medical records within seconds. 

By eliminating misidentification, mix-ups, and duplicates at the front-end, RightPatient ensures that the accurate medical record is used across the care continuum, eliminating denied claims, boosting bottom lines, and enhancing patient safety in the process.

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Optimizing Revenue Cycle Management in Healthcare is More Important Than Ever

While the US is still suffering from the effects of the highly contagious COVID-19, it has arguably hit its healthcare system worse than anything else. Around 1.4 million people working in healthcare have lost their jobs. The number itself is quite shocking, however, what makes it worse is that the pandemic has changed everything. For instance, the US healthcare system used to be unaffected by any recessions, but COVID-19 has shown otherwise. This is because numerous hospitals have declared layoffs, furloughs, or are even shutting down due to unimaginable financial pressure. With that in mind, as hospitals are opening up, they need to reduce their losses right off the bat, otherwise, it will be hard for anyone to survive. Thus, revenue cycle management in healthcare is more crucial than ever now.

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The numbers are drastic

It has already been mentioned that over 1.4 million healthcare professionals lost their jobs. That’s not where it stops, though. Since hospitals made the difficult but necessary choice to prepare for the overwhelming amount of COVID-19 patients by shutting down non-emergency care at their premises, they became financially crippled. The American Hospital Association stated that hospitals are losing a mindboggling $50 billion a month, due to the fact that they are seeing an extremely low number of patients – as low as 70%. Revenue cycle management in healthcare has always been a much-discussed topic, however, as the numbers show, it is of utmost importance now to optimize revenue cycles by reducing costs and mitigating losses – something that RightPatient can help healthcare providers with. But how does optimized revenue cycle management help hospitals deal with the financial crisis?

Benefits of optimized revenue cycle management in healthcare

Reduced denied claims

A streamlined revenue cycle depends on the level of accurate data present within the system. If there is a high level of accuracy, it reduces the chances of denied claims. Usually, denied claims occur when there are mistakes in payment claims. One example is when patients are mistakenly charged for services they have not used. RightPatient ensures that the patient is accurately identified from the beginning to the end of the process – substantially reducing denied claims. 

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Enhanced patient experience

An optimized revenue cycle means that the FTEs will spend less time on redundant tasks such as rechecking coding and billing for errors and focus more on providing better care to the patients – enhancing the patient experience. 

Higher and faster collections 

It is quite simple – if the revenue cycle is optimized, there will be higher collections with a lower number of errors. FTEs, thus, do not have their hands full of coding and billing errors – giving them the time to focus on the remaining collections, improving efficiency in the process. 

Accurate patient information 

An optimized revenue cycle means that you are ensuring patient data integrity; that is, from the beginning of caregiving to collections, the correct patient has been identified. This can be easily achieved using an accurate patient identification platform like RightPatient.

Better financial returns

One of the most vital parts of a healthcare provider that everyone scrutinizes, other than treating patients, is its financial performance. After all, these are the indicators as to how well a provider is doing. An optimized revenue cycle means that there are increased clean claims, faster collections, lower lost claims, and accurate patient data – all leading to improved revenue of the provider.

Since COVID-19 is still affecting the financial performance of providers, they need to ensure that their revenue cycle is as optimized as possible. 

Optimize revenue cycle with RightPatient

Optimized revenue cycle management in healthcare means that you need to have the correct data for the patient and you are ensuring that he/she is being billed accurately throughout the whole process. Thus, for a better revenue cycle, you need to ensure accurate patient identification. This is where RightPatient can help you.

It is a touchless biometric patient identification platform and is used by leading healthcare providers for a number of reasons. It prevents medical identity theft, optimizes the revenue cycle, reduces denied claims, prevents duplicate record creation, enhances patient safety, and more – leading to improved financials, boosting the bottom lines in the process. 

Upon registration, RightPatient locks the medical records of the patients with their photos. Whenever an enrolled patient comes in, all he/she needs to do is look at the camera and it identifies them within seconds, providing the correct patient record to the EHR user and ensuring accurate patient identification. This ensures that the correct patient is identified right from the start – reducing billing errors and denied claims and optimizing revenue cycle in the process. This is something that every provider needs to ensure to survive during this unprecedented situation.

RightPatient has years of experience and has been helping protect over 10 million patient records. Duke Health and Community Medical Centers, among others, are using RightPatient to ensure safe, hygienic, and accurate patient identification. Are you optimizing your revenue cycle sensibly? 

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5 Strategies to Ensure Revenue Integrity in Healthcare

Many healthcare providers were struggling financially before the pandemic. But now, the U.S healthcare industry is on the verge of financial disaster. According to the American Hospital Association, hospitals are bleeding approximately $50 billion per month due to canceled elective procedures and costs associated with treating COVID-19 patients. Many non-COVID patients have also stopped seeking primary care visits, including patients with life-threatening conditions, because they are worried about exposures. In addition, claim errors, denials, and payment delays that result from inaccurate patient identification, duplicate medical records, and medical identity theft still persist, all of which affects revenue integrity. 

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Adopting Value-Based Reimbursement (VBR) models has shown to have economic advantages but poses a real challenge for healthcare providers alongside ever-changing healthcare compliance regulations. Siloed workflows, data proliferation, and disparate systems make it difficult to achieve the collaboration that is needed for VBR to yield optimal results. However, intelligent revenue cycle management can be the key to achieving financial stability and revenue integrity. 

Identify the problem

Today’s environment requires automating workflows and considering the whole revenue cycle process to ensure revenue integrity. Healthcare providers want an easy, seamless way to manage revenue cycle without errors, such as those caused by patient identification issues. Considering the lack of electronic medical record (EMR) system capabilities to adequately address the critical need for accurate patient identification, it is vital to leverage complementary technologies with core-specific competencies that can improve the overall revenue cycle. For example, improving patient identification and matching processes at the front-end of the revenue cycle process can significantly reduce costs. 

As an industry-leader in touchless patient authentication, RightPatient has been helping many healthcare organizations reduce claim errors and denied claims by ensuring accurate patient identification. By eliminating denied claims linked to identification errors, healthcare providers can reduce the burden of back-end activities in the revenue cycle and simplify the reimbursement process to ensure revenue integrity.

Rely on technology

Adopting technology is also essential to ensure that clinical teams across the healthcare ecosystem are accessing high quality shared data to produce the best outcomes. Augmenting the organization’s core systems with complementary technologies on a single, integrated platform enhances internal collaboration with other teams or departments. For instance, RightPatient crosses departmental silos and brings transparency to patient healthcare data across disparate domains. Transparency across teams is critical. RightPatient will ensure that a holistic and accurate medical record of each patient can be accessed by clinical and operational staff members no matter where the patient is authenticated. By automating the patient identification and authentication process, RightPatient improves clinical outcomes and enables staff to proactively focus on other areas where their expertise has the most impact.

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Ensure compliance

According to the National Association of Healthcare Revenue Integrity (NAHRI), the goal of revenue integrity is to prevent issues that lead to revenue leakage or compliance risks through effective, efficient, and internal controls across the care continuum, supported by strong documentation and sound financial practices that can withstand audits at any time. 

Violation of healthcare compliance is a major contributing factor to financial losses. For instance, HIPAA violations are becoming more common across the U.S healthcare system. HIPAA compliance software, on the other hand, can help address this issue. Such software allows healthcare providers to simplify their compliance efforts and manage training through an effective communication system. Ensuring HIPAA compliance prevents privacy issues that can impact proper revenue cycle management and helps to avoid costly financial losses.

Accurate documentation and coding

Unfortunately, as long as healthcare providers do not address the issue of front-end data validation, claim denials will continue to wreak havoc. Inaccurate patient identification and medical identity theft still remain a major contributing factor to denied claims and payment delays. However, through accurate patient identification, RightPatient enables healthcare providers to bill and code each patients’ information accurately. By ensuring accurate and clinical documentation, this platform significantly reduces inefficiencies of denials and rework, thereby strengthening revenue integrity. 

Improve hygiene and foster patient trust with RightPatient

Healthcare providers are witnessing a reduction in non-infected patient activity due to the fear of COVID-19. Visits for general check-ups or other routine procedures have decreased to the obvious financial detriment of healthcare providers. These providers need to reassure their patients that they are taking all precautionary steps to maintain hygiene and control this contagious disease. Adopting RightPatient is a sensible part of this strategy. 

RightPatient is a completely touchless biometric patient identification platform that can accurately identify patients throughout the continuum of care. After capturing a photo from a smartphone, tablet, or webcam, RightPatient instantly identifies patients and retrieves their correct medical record. By securing unauthorized access to medical records, hospitals are able to prevent medical identity theft, reduce denied claims, and duplicate records – all of which are vital to a high-performing revenue cycle. 

RightPatient also offers remote patient authentication, which is becoming increasingly necessary as people are maintaining social distance by staying at home and getting treatment through telehealth practices. During this process, RightPatient validates patient identities by comparing their ID (e.g. driver’s license) and selfie photos. This process can also help healthcare providers to save money on more expensive identity proofing solutions through credit agencies. 

As patient care becomes more complex, so does the management of the revenue cycle. RightPatient can help to simplify and manage the complexity by ensuring safe, ubiquitous patient authentication from various patient encounter points. Full financial recovery from this pandemic may take years, but adopting RightPatient will ensure that you are on a faster path to success.

Patient identification helps improve revenue cycle

Hospitals Can Improve Revenue Cycle With Positive Patient Identification

The importance of digitization in healthcare delivery is becoming inevitable. As medical institutions and hospitals try to deliver a more value-based care environment, the RCM (revenue cycle management) has become more critical. According to HFMA/Navigant analysis, healthcare revenue cycle leaders are willing to invest more in technologies that will boost their revenue integrity, eliminate human error, and increase productivity in the future. All in all, they are targeting to improve the revenue cycle. 

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According to a report from Sage Growth Partners, one-third of healthcare providers have confronted more than $10 million in outstanding debt every year. Every year up to $125 billion is lost due to unpaid bills and underpaid claims, and the situation is nowhere near improving. As a result, more healthcare providers are demanding revenue cycle managers to revamp and automate their processes. 

Understanding the process flow

To understand how to improve revenue cycle management, we should know that it is usually divided into two separate parts, the front-end and the back-end process. The front-end revenue cycle management deals with patients directly. For example registering new patients, collecting information for patients, and confirming insurance eligibility and coverage. The back-end involves dealing with claims management, denial management, medical billing, and ultimate patient financial responsibility collection.  

Even with all the innovative ideas the RCM managers are putting into effect, healthcare organizations are still worried about:

  • Decreasing cost to collect
  • Providing quality patient experience
  • Reducing initial denial rates, which have gone up in both public and private organizations
  • Concerns about increasing out of pocket costs from consumers, which leads to payments being held up, delayed care, and uncollectible receivables. 

What can be done?

Instead of reaching out to professional RCM vendors, the healthcare providers and medical institutions can solve the problem with proper patient identification. The first essential step which helps to improve revenue cycle and reduce denied claims is to identify the patients accurately and bill them accordingly. Let’s look at the solution and the possible gains from this solution. 

RightPatient – Biometric Patient Identification Platform

A biometric patient identification platform such as RightPatient is a cutting-edge digital cloud technology used by many healthcare providers to address the sorts of problems mentioned above. Using biometrics has proven to be effective in identifying patients accurately.

How it works

During initial enrollment at the hospital, a patient’s biometric data like their iris or facial photos, will be used to keep their information locked and secure. Next time when the patient arrives at the hospital to avail of healthcare services, all he/she needs to do is just look at the camera, and the platform will identify their accurate medical records within seconds.

Halt denials before they start

Eliminating the problem at the front-end will ensure that you do not have to worry about back-end RCM staff dealing with denied claims. RightPatient will do that for you. Accurate patient identification from the beginning of the care will eliminate the risk of improper use of patient information, resulting in the rejection of claims. 

Who is using this solution? 

Healthcare providers such as the University Health Care System and Terrebonne General Medical Center are using RightPatient’s biometric identification platform to reduce the number of denied claims and improve their revenue cycle.  

Improve revenue cycle now

Using biometrics to identify patients has also proven to be effective in improving patient experience, reducing administrative burdens, and eliminating errors. Naturally, more time and resources can be invested to ensure the provision of quality care. Adding the front-end and back-end functions through RightPatient can help the hospital create a steady revenue cycle that responds to an evolving industry.

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Can Revenue Cycle Improvement Prevent Hospital Closures?

So many hospitals are closing their doors that it is hard to keep count nowadays. These closures happen for several reasons which we will discuss later. One of the latest ones to join this unfortunate group is Nix Medical Center, located in San Antonio, Texas. 

The 208-bed hospital once owned by Prospect Medical Holdings was acquired in 2012 and operated by Nix Health as the Nix Medical Center for 89 years.  

In addition to closing its hospital’s doors, Nix Health also had to close its home health division as well as Nix Specialty Health Center & Nix Behavioral Health Center, generating an estimated layoff of over 970 employees. 

Can Revenue Cycle Improvement Prevent Hospital Closures?

But why are these hospitals being closed?

Hospitals are supposed to offer health care and save lives. Thus the most important institutions in any society. So why are they being closing down? 

Well, the largest and most common reason is the lack of revenue. 

In this instance, with fewer people visiting Nix Medical Center the hospital simply couldn’t generate enough revenue to sustain it’s operational costs thus resulting in its inability to provide effective health care and subsequently closing its doors.

What to take away from this example?

Hospitals need to learn from this scenario and focus their efforts on better financial management via reducing denied claims via revenue cycle improvement. 

Known to cost any health system an average of more than $5 million each year, denied claims often occur due to mistaken billing of patients. For example, a patient visiting the hospital for a routine checkup is billed the cost for a surgical procedure and vice-versa. While this may sound peculiar you would be surprised to know just how common it is. Although 63% of initially denied claims are recoverable, they can cost as much as $8.6 billion in appeals-related administrative costs and why hospitals must find ways to mitigate such losses.

How can hospitals achieve revenue cycle improvement?

One way health systems can achieve revenue cycle improvement and lessen denied claims is by ensuring patients are correctly billed for the healthcare provided. 

To achieve this many progressive health systems are using RightPatient – a biometric patient identification platform. By implementing RightPatient, medical records are locked to each patient’s biometric data thus preventing unauthorized identity theft. 

Health systems such as Terrebonne General Medical Center and University Health Care System are already using RightPatient and are preventing medical identity theft, patient mix-ups as well as denied claims. RightPatient effectively reduces loss in revenue by ensuring each patient is billed correctly for the healthcare provided. Using biometric data, patient misidentification is also prevented. Each patient is required to register only once after a health system deploys the platform – attaching the biometric data with the EHR of the patient. Afterward, whenever that patient visits the hospital, RightPatient uses their biometric data to access their respective medical records for the previous diagnosis and prescribe the necessary treatment.