Top 5 RCM Challenges in Specialty Healthcare
Revenue Cycle Management is critical to ensuring the profitability and long-term viability of healthcare organizations. The ability to collect revenue and use it to improve the quality of care provided by clinicians improves the healthcare entity’s trust and brand.
The healthcare industry is beginning to use robotic process automation and artificial intelligence to manage its revenue cycle in today’s digital era.
The adoption of automated workflows has resulted in fewer errors, higher collections, and increased overall profitability. Despite these advancements, some RCM processes, particularly in specialty healthcare, continue to have gaps.
Due to the specialty-specific nature of healthcare, your revenue cycle processes necessitated the use of specialized resources with specialty-specific skills.
Because of the frequent changes in regulations, RCM for specialty healthcare can be daunting for most healthcare organizations. It can also be difficult because it necessitates attention to financial and administrative issues that have a hyperbolic effect on the company’s financial stability.
This article discusses some revenue cycle management challenges in specialty healthcare, as well as some tools and strategies for dealing with them.
Challenges of Revenue Cycle Management
Given that Revenue Cycle Management is a fairly complex aspect of healthcare, there are some challenges that you should be aware of.
According to Derek Bang, CPA, CGMA, Chief Innovation Officer at Crowe Horwath, “the front-end of the revenue cycle must be diligent with determining Medicaid eligibility and (help) uninsured patients understand their coverage options with the insurance exchanges,” according to a recent report from Revenue Cycle Intelligence.
Bang also mentioned that, as patients become more responsible for their payments, organizations will need to focus on collecting fees at the point of service.
Another issue that some medical organizations are still grappling with is the latest version of the International Classification of Diseases code.
Strong Prior Authorization Processes
Prior Authorization is the process by which a provider obtains payer approval before providing any service to a patient. Prior authorization aids in cost containment and allows providers to provide patients with evidence-based treatment.
Previous authorizations are important in specialty healthcare because specialists can create a treatment plan that meets the requirements of various payers.
As a result, outsourcing your prior authorization process to an RCM company that understands specialty-specific prior authorization requirements can help you improve your clean claim rate, decrease denials, and increase reimbursements.
Revenue Integrity – Collecting the correct fees
Charge entry is one of the most crucial processes in medical billing. The charge entry process determines the reimbursement a physician receives for the services rendered.
Because many specialists participate in a value-based care program or bundled payment programs, the charge entry process becomes more complicated in the specialty ecosystem.
Multiple systems generate various information that aids in diagnosing and treating patients with highly complex diseases, which adds to the complexity.
As a result, healthcare organizations should start moving toward data interoperability to address issues with charge entry. Charge entry outsourcing can help you achieve charge capture accuracy of greater than 98 percent and reduce charge entry lag
Perfect Medical Coding
One of the most difficult aspects of revenue cycle management for a specialty healthcare provider is coding. The rapid evolution of ICD-10 guidelines for specialty healthcare necessitates coders staying current on every nuance of correct practices.
Outsourcing their specialty coding needs to an offshore healthcare revenue cycle company can help them deal with payment challenges caused by frequent changes in guidelines.
A/R is meticulously managed
While managing the A/R, account receivable benchmarks for the specific specialty must be adhered to. Days in accounts receivable can be kept under 30 days with the help of a dedicated team of accounts receivable and denial management professionals.
Credentialing
The credentialing process verifies that a doctor meets certain criteria for providing clinical care. The Payer checks the physician’s credentials, including his or her education, license, and specialty accreditations. These have a negative impact on the practice’s finances.
Specialty healthcare providers must ensure that their credentials are appropriate for their skills. Providers who have previously been credentialed should provide current information on how to obtain any new specialty certification.
Allowing outside credentialing specialists to handle your credentialing needs will help you avoid reimbursement mishaps.
CONCLUSION
The quality and capabilities of your RCM service provider are directly proportional to your financial stability. An RCM service provider with specialty-specific expertise can help you improve your healthcare organization’s financial health.
