RCM continues to trend toward automation

Oct 03, 2019

Despite obstacles such as cost and security, RCM departments continue to push toward automated solutions to improve the patient experience and maximize reimbursements.

We live in an increasingly automated society. From ordering coffee on an your phone to asking Alexa to write down your to-do list, you can now complete processes faster and more efficiently than ever before by leveraging cutting-edge technology to do the footwork for you.

And healthcare revenue cycle management is no exception.  

Despite obstacles such as cost and security, RCM departments continue to push toward automated solutions to improve the patient experience and maximize reimbursements. Specific trends in 2017 have included enterprise resource planning systems, cloud applications, data analytics and outsourcing – strategies all intended to increase the efficiency and accuracy of the RCM process.  

Investment in enterprise resource planning systems
In your RCM department, your staff need to budget their time and resources effectively to ensure that claims are completed correctly and on time. Often, that can mean learning through trial-and-error attempts at coordinating team members and tasks.

Luckily, there's a better way. 

Many organizations are opting to invest in enterprise resource planning systems to ensure that they're maximizing their workflow to ensure the highest possible reimbursement rates. According to a report on 2017 RCM trends by Black Book, 93 percent of CFOs believe that ERP is necessary to adequately achieve supply chain efficiency, price transparency and true costing in value-based care.  

This type of automation in healthcare means that your staff have time to focus on the tasks that most require their attention, improving your department's ability to meet deadlines and increase reimbursements without the necessity of additional employees. 

Cloud applications as the primary storage platform
In healthcare and beyond, the cloud is becoming an increasingly popular home for information storage. A McAfee white paper reported that 93 percent of organizations currently use cloud services and 74 percent store sensitive information in the public cloud. 

"In RCM storing information in the cloud is quickly becoming the norm."

In RCM, storing information in the cloud is no longer novel – it's quickly becoming the norm. According to Black Book's 2017 Trend Report, more than 55 percent of CIOs are confident in their strategy for cloud applications.  

But looking forward, these professionals now need to think about disaster recovery. The survey found that 83 percent of healthcare organizations don't have cloud storage that would allow them to recover information in the event of a disaster. 

Cost-estimation through data analytics
When consumers walk into stores, the prices of each product or service are typically clearly labeled and customers know how much they'll pay before they step up to the register. So when it comes to medical billing, patients can become quickly frustrated over the lack of price transparency. Creating estimates involves coordination between billing departments, insurers and more.

To improve this process, some organizations are turning to cost-estimation solutions which use data analytics to not only give patients the cost information they want, but also aid healthcare groups in obtaining the data they need for the successful claims resolution that leads to increased reimbursement rates. 

Strategic use of RCM outsourcing
Throughout 2017, healthcare organizations have strategically used RCM outsourcing options to increase the success of their claims resolutions. 

In fact, a report by Black Book predicted that the market for ambulatory and physician RCM outsourcing, as well as extended business office services, in the U.S. is expected to grow by 42 percent between Q4 2016 and Q1 2019.   

"Rising healthcare expenditures and the complex technology or staffing requirements to succeed under value-based care is creating the urgent demand for cost-effective, technically advanced business office outsourcing solutions in physician practices across the country," said Doug Brown, managing partner of Black Book. "High-impact drivers of the physicians practice outsourcing market include the increasing emphasis on compliance and risk management, and the need for more efficient and cost effective processes," 

To learn more about how outsourcing your specialized claims, such as workers' compensation and motor vehicle accident, can help streamline your healthcare revenue cycle management department, contact PROMEDICAL today. 
By doug 22 Jul, 2020
In 2016, healthcare vendors need the most efficient claims processing systems out there. By now, flexible, web-focused methods for important claims tasks are clearly the industry's path forward, and will play a major role in bridging the gap between patients and providers. A fast, digital claims method makes a direct link from implementation to delivery for workers' compensation and motor vehicle billing alike. Now is the time to invest in better revenue cycle management, with a focus on detail-driven, well-facilitated collection that breaks down barriers. Despite the growing pains involved with adopting any new technology, there are a couple of areas where smarter systems have already improved claims processing online. Direct accessibility With each new convenience, the future of healthcare looks more integrated. Data analytics harvests insights from seemingly unrelated details for fuller results. To make this innovation worthwhile, however, there needs to be a distinct pipeline between entities. "Data analytics harvests insight from seemingly unrelated details." Online healthcare portals are already addressing this need, providing direct communication through smart devices like phones and tablets. By bringing necessary information together in a simple, accessible source, these solutions set the stage for clean claims assembly. Shorter cycles Proper collection from the outset can reduce the amount of work hospitals have to do later if the claim is resubmitted, according to Gary Marlow, Vice President of Finance at Beverly Hospital and Addison Gilbert Hospital. "From a revenue cycle perspective, getting the most accurate information up front starts with patient scheduling and patient registration," Marlow told RevCycleIntelligence in 2015. "That provides the groundwork by which claims can be billed and collected in the most efficient and effective manner possible." The way information enters the claims process can impact how it gets managed. If technology, like artificial intelligence, is present at the beginning and guides the claims throughout, there's a consistent system handling the information the process to meet best practices. PROMEDICAL's benefits With our secure, efficient and comprehensive system, PROMEDICAL is staying ahead of the game. We're doing that by developing the following features: Communication: Users can choose from multiple languages with our online offerings. This allows you to customize your system to better reach patient populations and keep claims moving faster. Customization: If our proprietary options aren't currently meeting your needs, we can change them to do so based on feedback. Adapt to state fee schedules or language demands on a case by case basis. Encryption: A must for secure file exchange, PROMEDICAL ensures a secure file transfer process. Our process protects backup data equally strong as primary data, for efficient security across the board. Planning: Organizations also benefit when a set deadline is involved, putting clear limits on when submissions are set for review. Processing records requests within a preordained period of days helps managers know what to expect, and regular reports set up clear overviews of important statistics. Contact PROMEDICAL today to learn more about our healthcare revenue cycle solutions.
By doug 02 Mar, 2020
According to Pew Research, 15 percent of U.S. adults have used ridesharing services . Where does insurance enter the picture? Uber, Lyft and other ridesharing apps throw a proverbial wrench in hospitals' revenue cycle management operations. Billing is already a major pain point in hospitals – Black Book Research noted most facilities are outsourcing their RCM because in-house teams lack the resources to efficiently handle motor vehicle reimbursement. Ridesharing will only exacerbate the issue. For example, if a rider gets injured and has to go to the hospital, from which institution does the hospital receive reimbursement : The driver's insurance? The passenger's? Uber's? As Uber and Lyft are the most popular ridesharing apps, we'll focus on how these companies handle driver insurance. How do Lyft and Uber insure drivers? Lyft has three types of coverage within its insurance policies: Contingent Liability activates when a driver logs into the app and requests to accept rides – a state Lyft designates as "Driver mode." This coverage provides up to $100,000 per accident for bodily injury. Contingent Comprehensive and Collision kicks in when a driver has picked up a passenger. This coverage applies when a non-collision event damages the driver's vehicle. Uninsured/Underinsured Motorist applies when an at-fault driver who is uninsured or underinsured causes bodily injury to himself, his passengers or any third parties. The coverage provides $1 million per incident, and includes no deductible. For example, if a driver is injured in an accident at a time when he is not working for Lyft, his personal insurance will cover him (assuming he lives in a no-fault state, but that's another issue). However, when the driver activates Driver mode, Lyft's Contingent Liability will protect him even if he hasn't accepted a ride from a passenger. What if the driver's at fault? According to Rideshare Dashboard, Lyft's commercial insurance will cover all damages to third parties and the passenger, but the driver will have to cover his own medical expenses. That's when state laws dictate payment. In Massachusetts, for example, which also happens to be a no-fault state and requires all motor vehicle owners to possess auto insurance, the rider's personal auto insurance will cover the medical bills. Uber's insurance system is somewhat similar to Lyft's but possesses a few minor differences. For example, when an Uber driver is transporting a passenger, and another motorist causes an accident that results in bodily injury to the driver, the passenger and anyone else involved, Uber's UM/UMI will cover bodily injury of anyone in the rideshare vehicle.
By doug 28 Jan, 2020
With new, transformative technological advancements on the rise, it's no surprise that nearly every industry is feeling the impact of the digital age. From a healthcare provider's perspective, new resources can be used to revamp the current revenue cycle management processes you have in place. To reap the benefits of an optimized approach, you must be willing to take advantage of such emerging technological tools and resources, as stated by Chad Sandefur, Director and Healthcare Analyst at AArete. "Generally speaking, in order to strengthen the revenue cycle management, embracing technology within the revenue cycle is key," Sandefur shared with RevCycleIntelligence.com. "Having the platforms to seamlessly facilitate provider-payer interactions are really integral. In many cases, it's mostly about bad debt avoidance. With that in mind, there are a few specific points." Let's take a closer look at the benefits of utilizing technology, plus some of the emerging resources your facility can use to revamp your current RCM processes: The benefits of an optimized approach By paying attention to the new digital advancements that can benefit your RCM, you can ultimately impact the workflow of your staff members while better streamlining services for consumers. Here are some of the advantages of an optimized approach: Reduced chance for human error – Human error is inevitable when handling large amounts of data. Management software can be used to keep track of patient data input and maintenance. Better opportunity for precise, automated data entry – Between appointment scheduling, data input and claims submission, employees have a lot of duties. Automated software can take care of some of these responsibilities, allowing staff members to better focus on a single task at a time. I ncreased cash flow – Claims management technology can expedite claims quickly and produce clean, accurate claims, ultimately increasing cash flow , as stated by Becker's Hospital Review. Optimizing your RCM approach can lead directly to a significant return on investment and improve the overall reputation of your billing department.
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