The majority of healthcare organizations provide practitioners with practical ways to go beyond traditional fee-for-service business models in their revenue cycle management strategy. Due to the challenges with insurance coverage, businesses in the alternative and integrative health industry, such as acupuncture clinics or chiropractic offices, frequently need to take cash payments. However, dealing with standard medical treatments may provide unique challenges when taking cash payments.
A distinct set of issues arises for traditional medical treatments while accepting cash. First, whether the debt is motivated by a pressing financial concern or a “real cash” issue, like the requirement to collect full payment from customers who lack health insurance, is true.
Concerns regarding cash payments are confidently addressed by healthcare revenue cycle management. Here are some suggestions that will be of great assistance to you.
What is the practice’s RCM for health care?
Depending on the services provided, businesses specializing in revenue cycle management identify, collect, and manage the cash of medical practices. According to this logic, revenue cycle management (RCM) describes the steps necessary to manage those areas of a practice’s financial performance properly.
The healthcare revenue cycle involves all parties engaged with the medical practice, including patients, staff, providers, and payers. So, introducing a cash payment system or improving the present cash payment approach can positively influence the practice’s whole healthcare revenue cycle.
A hospital that takes fees for its services
When it comes to accepting cash payments, there are numerous areas that healthcare debt collection firms need to pay particular attention to. The main revenue flow includes the following items:
Performance
The first step is to take into account the operation’s performance and payment patterns. It is a procedure or service that is covered mainly by several payers. In the meanwhile, the staff will be adequately informed of this. Whatever treatments or procedures raise eligibility questions should be crystal apparent to your practice and the medical collection agency. This is exceptionally crucial when the practice has an integrative or complementary component.
The critical components of businesses that provide revenue cycle management are described in further detail below:
Possibility of frequent insurance verifications
Putting up a lot of effort to investigate, review, and keep track of claim denials and the reasons behind them.
Looking at your healthcare revenue cycle analysis from this perspective can help you establish a baseline for how to accept cash payments and which services are made more accessible.
Money, payment of the charge, and receipt of knowledge
Both patient involvement and education are necessary to establish a solid patient-provider relationship. One of these qualities is being upfront and honest about the services provided and any needed billing. It is crucial to initiate a conversation with the patient about the billing component of their care, even if you anticipate or hope that treatments or procedures will be reimbursed. You may build trust with them by demystifying the cost of care and informing the patient of the sticker price.
By running such information, they can assess what is valuable and what is not. For instance, before a patient becomes emotionally connected to the idea of something they can’t afford, they should be given accurate financial facts regarding elective surgeries.
Collection tactics
A patient’s eligibility for coverage for a procedure or therapy you are convinced will be covered must be confirmed. Every practice must make a choice, and if yours decides to move forward, there are specific strategies to use to make sure it gets compensated for at least some of the costs related to the service or treatment.
Accepting deposits for less-priced services makes sense since it keeps the revenue cycle active. You can either return the patient’s deposit or continue billing them as usual for the outstanding balance until you’ve heard back from the insurance company or another third-party debt collection agency. The approach is also helpful in educating patients about their financial responsibility in their treatment because they are aware of the coverage risk upfront.
Internally or externally
The market for RCM outsourcing is already established. The main issue, ownership, and control of the operations will be resolved by healthcare revenue cycle management companies by utilizing real-time technology to allow operations leaders to assess the performance of the extended business office.
They have promoted seasoned operations leaders to client services positions to promote a cooperative and problem-solving culture. But unfortunately, it is challenging for healthcare executives to plan and implement outsourcing projects. Problems with the decision-making process include:
The difficulties of working with team members from different cultural backgrounds in a global context add to the complexity of the outsourcing option. A skilled service provider deals with all these issues in a comprehensive transition and transformation program. The ideal service provider will be able to meet your business demands while educating clients on how to choose the finest transition partner.
Proposals for contracting out the revenue cycle
In an organization that manages the revenue cycle, there are several options for outsourcing. Sadly, these concepts make it challenging to choose between outsourcing or maintaining the processes in-house, from bad experiences with previous RCM service providers to the necessity of understanding how outsourced programs should work.
You are aware of the difficulties in obtaining resources, the erratic reporting practices, the issues with quality, the inability to meet industry benchmarks, and the requirement for more excellent expertise in specific fields, such as CDI. Therefore, using a quantitative, data-based approach is highly recommended when assessing the success of revenue cycle outsourcing operations.
We recommend keeping an eye out for internal issues, setting acceptable objectives and KPIs for outsourced engagements, and expecting more from the outsourced partner than is possible on your own.
Outsourcing is a multi-year journey with a reliable partner. The importance of enhancing financial outcomes annually should be increased. The emphasis is on the entire “connection.” The sole goal should be to provide a secure atmosphere where the outsourcing partner can freely discuss delivery issues and challenges.
Management of transitions
When outsourcing, the primary concern is what will happen to in-house billers and developers. Lately, internal teams have had a lot of staffing needs. It could solve the issue of what to do with internal team members more rapidly. The staffing model is frequently temporary. The internal healthcare revenue cycle management team members can move into different roles with the proper training.
One of the finest strategies is to make a minor outsourcing adjustment. Yet choosing to outsource the entire department risks weakening established practices and hurting overall cash flow. Instead, the progressive expansion of outsourced operations benefits the focus on crucial internal resources, the maintenance of process knowledge, and change management programs.
It would help if you invested in improving the internal team’s responsibilities and job descriptions as you broaden the scope of your outsourced activities.
Objectives of outsourcing
Costs
Because most hospitals and healthcare organizations run with negative margins, cost reduction is crucial. Nevertheless, while most service providers may generate labor arbitrage-based savings, only a small minority can consistently uphold and enhance that savings model.
RCM outsourcing commonly uses per-transaction monthly fees and contingency-based pricing, such as the overall percentage of collections for end-to-end RCM outsourcing or backlog clearance activities. Moreover, collaborating with a service provider that offers a range of pre-built automated solutions decreases the cost of collecting and eliminates the need for manual labor.
Revenue leakage
Healthcare organizations lose between three and five percent of their revenue due to issues like DNFB and addressable rejections. The fundamental problems are:
This revenue loss, which typically exceeds three times what you pay an offshore revenue cycle service provider, makes the whole outsourcing program cheap.
Patient Satisfaction
The introduction of high-deductible health insurance has increased the importance of patients as a source of service finance. The outsourced staff will manage appointment scheduling, registration, calculating self-pay, and collections with efficiency and compassion.
A smooth transition
Achieving sales objectives on time is comparable to completing a marathon. Here, the remote office must be successfully set up for use in business. Putting a structured transition and governance mechanism in place would be the wisest course of action. Building multi-tier governance structures and providing proper knowledge transfer is increasingly crucial so executives and contracted teams can work together to meet KPIs. For instance, the executive team will only participate in quarterly meetings, and the leadership team will be in charge of assigning responsibilities. Organized governance procedures will protect this.
Wrapping Up
Decision-makers in healthcare revenue cycle management companies would be wary of outsourcing. Outsourcing operations must consider several factors to be effective, including cash flow, quality, people, and change.
The right partner might speed up the procedure and produce long-term financial success. As a result, hospital financial operations may now be a strategic pillar for transformation and a means of obtaining elusive profits.
Calculating the financial ROI.
Developing metrics to assess the performance of the extended business office.
Changing the roles of team members.
Inefficient clinical recording.
A lack of medical education programs.
Ineffective follow-up.
Rejection of clearing programs.