Top challenges in healthcare RCM faced by Hospital CFOs

 Tom Jenkins Billing & Collections, Medical Billing, Most Recent, Uncategorized

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RCM Challenges faced by Healthcare Providers specially hospitals CFOs

New technologies often quickly shape behaviour and induce change in healthcare, this change comes with challenges. Healthcare is a complex process and revenue is dependent on factors like insurance TAT, medical records etc.  “Missed appointments are especially troubling, as 40% of patients reported forgoing care.8 Each of these open, unused time slots costs up to 60 minutes and $200.” reported in a survey. In this article, we discuss some of the challenges is RCM.

1. Adopting a Patient-centered care Approach

Patient-centered care is a term used in healthcare that implies ‘patient’s needs come first’ Healthcare providers can spend more time on patient care by outsourcing their medical billing process. In a survey by HFMA, 90% of medical practioners said that the biggest issue faced by their practice is the burden of Paperwork. Patient-centered care as ripple effect towards the medical group practices

Studies reveal that patient perception is primarily based on their experience with consultation and insurance reimbursement. It will become increasingly harder for the staff if they are occupied with administrative work. With the constant changes in healthcare guidelines, it will be harder for the staff to be patient-centric. 

2. Maintaining a Constant Cash-flow

During COVID-19 many states have banned elective surgical procedures that have experienced a significant decrease in cash flow for the healthcare providers. collecting patient-pay accounts also become challenging. Enforcing adherence to charge capture and reconciliation policies can reduce late payments Providers may have accounts receivable from services performed prior to closure, collecting these receivables may be challenging for many practices. 

3. Workflow mismanagement

Managing workflow in healthcare is no simple task. Hospitals and medical practices can avoid unnecessary patient delays with proper workflow. Once a Patient received a bad experience because of delay it can impact the reputation of the medical practice. Admission often requires patients to go from desk to desk to sort out and proceed to the next step. Few Hospitals have medical records that are updated clearly by every doctor who has treated patients and understood clearly by the follow-up doctors who looks at them.

4. Timely follow through on claims

Some insurance companies delay payments and might send an unnecessary denial. If the Billing team is not updated with the insurance guideline and industry trends, it will be difficult to improve the reimbursement rate. Following a claim with the insurance A/R team should constantly communicate with the patient, service provider and Insurance firm to take the necessary action to resolve any claim. Maintaining records of common denials and how to resolve them, identifying global issues will save a lot of time. 

5. Optimizing towards a digital workflow

In the digital era, most patients use online search before making an appointment with a doctor. A survey concluded that 80% of consumers would prefer a doctor with online scheduling over one who doesn’t. It is beneficial for medical practices to transition to digital tools for the patient registration process. While adopting digital technology will require the hospital to install devices and servers and troubleshoot them if required. Training staff and physicians with the technology can be challenging.

6. Changing insurance guidelines

The insurance industry is undergoing constant changes in guidelines according to federal and state laws. If the patient is paid for the service once is not a guarantee that it will be reimbursed the next time also. Having a well-organized medical record and electronic health record will remove friction while sending appeals to the insurance. Monitoring all the gaps in the regulation of the insurer can be a challenge for healthcare providers. 

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Over 12 years of experience as an RCM specialist. I have hands-on experience in most parts of the RCM Cycle. Currently designated as Manager – Operations in BillingParadise based out in Diamond Bar, CA. We offer Billing services and Healthcare IT solutions which in turn will improve the cash inflow of the Hospitals and Clinics.

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