Article

Improving financial performance with a revenue cycle management system

Independent medical practices are facing an increased administrative burden that could potentially cause an operational crisis. To reduce that pressure, practices need to implement a revenue cycle management solution, which can also maximize practice efficiency and boost financial performance. When considering the right revenue cycle management option for financial stability and success, independent practices need to identify services that can handle new methods of reimbursement.

But typical revenue cycle management solutions are not properly equipped to meet the demands of practicing medicine in a new, value-based healthcare environment. New payment models require a healthcare revenue cycle management system that can track — and submit — cost and quality data, as well as process and appropriately distribute compensation based on practice performance.

With a standard revenue cycle management tool, independent physicians may not be able to maintain their practices’ efficiency and profitability while keeping up with payment reform. Even with a solid solution for revenue cycle management, there’s still a demand on practice staff to spend hours sorting through changes enacted by commercial and government insurance payers, tracking claims, and managing appeals — all while giving patients the attention and care they require.

Independent practices should look for healthcare revenue cycle management solutions that integrate both front-end and back-office knowledge and support into the practice workflow. In this case, health IT vendor teams can take on tasks such as patient scheduling, claims submission and tracking, and researching and implementing real-time updates to payer rules; this relieves much of the burden on practice staff, enabling them to focus on other business goals.

Here other offerings which independent practices should look for from revenue cycle management systems:

  • Efficient delegation of patient scheduling, billing, invoicing, claims processing and other revenue cycle management activities to keep denials low, days in accounts receivable (DAR) down, and the practice focused on patient care
  • Ongoing visibility into financial performance, so practices can make improvements and plan intelligently for the future
  • The ability to reconcile group and individual payments against services provided, to track costs and outcomes
  • The ability to take in lump sum payments, and allocate those to appropriate staff according to contract terms
  • Close coordination with electronic health record (EHR) software to link clinical and financial outcomes, demonstrate success, and identify where improvements are needed to maximize reimbursement and provide the highest quality patient care
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