The execution of the concepts of artificial intelligence and automation are prominent. Many sectors today are utilizing these technologies to optimize the work process. The same can be applied to the healthcare industry. Such technical advancements provide plenty of opportunities in the medical billing segment of the healthcare sector.
One of the key criteria for this sector or perhaps any other industry is the RCM. It stands for revenue cycle management, and the success or failure of a business depends upon its implementation. It is a complex but critical process for a business. Following are the prominent factors associated with revenue management cycle from the perspective of the healthcare industry.
What precisely are RCM in healthcare and the challenges faced?
The RCM from the perspective of the healthcare industry focuses on the payment lifecycle as the hospital treats a patient. There are plenty of stages in this whole cycle starting with registration. It is after the treatment, that there is a claim generation on the behalf of the hospital management or precisely the billing section. The third step is about making sure that there is the proper submission of the claim to the person responsible for paying. It is not always the patient because, in the case of a minor, it could be a guardian who will be making a payment. The final phase of this cycle is about collecting the cash for the person responsible for making the payment.
What are the challenges?
The aspect of medical billing to finally the claim collection process seems fine. However, the experts point out that the process has a few drawbacks as well. Here are a few updates on some of the areas, which experts suggest generally tend to slow down the whole process
- One of the most common areas, where the whole cycle faces a challenge is the denial aspect. Just because hospital management may have made a claim, it does not mean that the payer will have to agree. He/she may deny certain aspects, and that slows down the whole process. The denials often tend to lead to a lower cash realization amount from the person responsible for paying, and in the process, it leads to reduced cash flows.
- There could also be some regulatory errors or compliances from the part of the hospital management. There may have been a failure to maintain the necessary HIPAA and HL7. These errors could lead to a breach of a patient’s data.
- A slow billing process could often be at fault. If the hospital still runs the manual billing, it is bound to be slower, and that has an impact on the RCM cycle.
- It could just be a general issue of wrong code generation from the RCM team, and this could always complicate matters.
What is the solution here?
We have discussed the problem, but there is certainly a solution to everything, or else the healthcare industry would not have been able to make progress. Following are a few solutions, as mentioned below:
- We have spoken about coding errors, which often tend to delay the revenue collection cycle, and the solution here will be to use analytics powered medical coding solutions.
- The medical billing errors are often the source to claim denial, and as a solution, one can look to integrate it with EMR automation. The inclusion of machine learning-powered denial management systems can boost optimization here.
- The implementation of automated data reading and artificial intelligence-based ICR solutions for payment posting will be able to boost up accuracy and speed.
Conclusion: The above-mentioned, systems will surely help to boost up medical billing alongside the revenue management cycle. The process will also improve the cash flow cycle for the healthcare industry.