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Treatment Options for Anemic Health Care Revenues

SYNERGEN Health
May, 2021
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Tips on how to address RCM challenges due to the recent COVID-19 crisis
By Teri Schmidt, Vice President, Consulting & Business Development, SYNERGEN Health

Some radiology centers have fared better than others in the months since COVID-19 reached American shores. Although the critical nature of imaging services allowed practices to remain open for business, decisions by health care systems and local governments to limit or suspend elective procedures constrained patient visits and squeezed revenue streams in markets across the country.

Adjustments have been costly. Some practices have added infrastructure for teleradiology, and many either elected or were compelled to shift non-essential or at-risk personnel to working from home.Organizations not already prepared for remote staffing may have incurred unanticipated expenses for communications equipment, including the need for additional bandwidth and software.

Rapidly implemented transitions to new working arrangements have also exposed challenges with record-keeping, billing and administrative functions, each with the potential to inhibit normal revenue generation. These operational changes have coincided with increased pressure on health care providers related to patient outcomes and the need to keep up with rapidly evolving compliance and reimbursement rules.

By stress-testing radiology centers, the pandemic has underscored the importance of contingency planning and adaptability for continued success. Prepared providers were better able to stabilize facilities and minimize further disruptions while creating new employee models and ensuring the safety of patients and staff.

On the business side, the ongoing crisis demonstrates the necessity of carefully managing the revenue cycle in a leaner health care sector. Moving forward, those imaging centers that build a stronger financial foundation as they modify operations will be in a more stable position post COVID-19.

Revenue Remedies

What follows are key considerations to help administrators detect and address revenue gaps, improve cashflow, and boost future performance. In most cases, the organization’s chief information officer will be best suited to lead this review, bridging financial and data activities to implement new capabilities that drive the business.

  • Focus on the patient. Remembering that the health care revenue cycle begins with a patient’s need for care, examine interactions and processes for opportunities to improve the patient experience. Patient financial responsibilities continue to increase, and individuals and households may be experiencing additional hardships associated with rising unemployment rates. Care providers can help patients minimize liability by verifying benefits in pre-visit communications or online screening. Equip the staff for this task with automated insurance eligibility checking, if available. The lower the patient’s personal liability, the more likely that billing and payment will proceed smoothly. And given the current economic environment, review collection policies and consider temporary adjustments that may enable patients to pay down outstanding balances. A patient-centric revenue cycle management system should integrate tools that make it easy for patients to make timely payments. These can include consumer-friendly electronic statements, as well as multiple payment channels and payment plans that give users the flexibility to make payments at any time and from any place.
  • Optimize coding. Investments that help care givers and support staff stay on the same page with payers’ coding conventions can pay for themselves in the form of reduced denials and better cashflow. Ensure not only correct reporting, but also mechanisms to consistently check for accurate reimbursement of all performed procedures. Solutions available to radiology centers today leverage artificial intelligence to automate facets of the insurance coding process. In choosing a product, look for a system that will allow automated deployment and integration into the organization’s existing billing software.
  • Track performance. Increase visibility into financial metrics to guide decisions and set priorities and objectives. Leaders will be better informed when they know how the center’s experience stacks up against industry norms and best practices. Depending on its complexity and the metrics tracked, an analytics platform can identify gaps in the revenue cycle, such as inefficient practices or recurrent errors that can be corrected for better cashflow. Executive dashboards that help decision makers visualize performance trends are invaluable in triaging a health care organization and in streamlining to increase efficiency. Platforms tied to multiple data sources can provide on-demand insight into the organization’s financial ecosystem.
  • Leverage technology. The complexities of delivering, billing, and collecting payment for health care services today demand a sophisticated approach to revenue cycle management. Available solutions enable health care organizations to optimize their financials using artificial intelligence, robotic process automation and other tools integrated into user-friendly platforms. Look for systems that can automate the tasks that have the biggest impact, such as verification of benefits, pre-authorizations, appeals and handling of aged receivables.

COVID-19 has accelerated changes in health care and the economy that require caregivers to reexamine their operations. This new environment demands more than reactive attention to revenue cycle activities; organizations intent on maintaining financial stability and growth are transforming their approach to revenue cycle management, establishing robust platforms that will support their success in the years ahead.

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