Effects of Value-based Care on Revenue Cycle Management

In addition to dealing with patients who are expected to pay a more significant portion of their medical bills out of pocket, healthcare providers are also attempting to make up for this lost revenue.  

The prevalence of high-deductible health insurance, free-care initiatives, and crowdfunding leaves medical practices and hospitals exposed to the ability of the patient to pay. It’s no secret that consumers demand an experience that mirrors their interactions with other consumer services, especially considering the rise of value-based care. They are more concerned about their health and are aware of their possibilities. 

Why Should Healthcare Providers Implement Innovative Revenue Cycle Management Solutions? 

Healthcare providers must change and adopt innovative RCM techniques since existing revenue mechanisms are not designed for the value-based system. They were rather designed for volume-based financial models. Thus, developing revenue cycle management strategies for guiding patients through the financial aspects of healthcare and streamlining the patient collection process is critical. 

Therefore, this guide will discuss the impact of value-based care on revenue cycle management, the gaps that make medical practices lose revenue, and tips to close this gap using effective RCM strategies. However, suppose you don’t want to handle the issue related to RCM and lost income in-house. In that case, we recommend you outsource your medical billing to a professional revenue cycle management company like CareCloud.  

Benefits of Outsourcing RCM 

When you outsource your revenue cycle management to professionals, you get the following benefits: 

• Denial Management 
• Medical Coding Optimization 
• Eligibility Verifications 
• Patient Collections 
• Reduced A/R days 
• Accounts Receivable Follow Up 
• Charge Capture and Billing 
• Claims Review and Submissions 
• Steady Cash Flow 

How much do healthcare revenue cycle management solution cost? According to Software Advice, RCM solution company helps you increase your collections by 10%, resulting in a profitable partnership. 

The Impact of Value-based Care on Revenue Cycle Management (RCM) 

Due to the transition to value-based reimbursements, patient-centered incentives, and quality-of-care programs, your clinical and revenue cycle operations need to be better integrated. Consistent and accurate communications must be given to patients throughout their healthcare journey, positioning them for the greatest potential health outcome and payment options. When the care and financial functions collaborate properly, your patient data is kept updated, and the right admin tasks are triggered at the right time.

The following features of RCM solution may be absent from your revenue cycle management process, making you lose your revenue:  

• Ability to cooperate with payers to create unique workflows, convenient processes, and accurate patient identification from registration to billing. 
• Simplified workflows to save time and resources on unnecessary jobs. 
• automated methods to aid in effective collections and identify the denials’ underlying causes.  
• Real-time reporting to assist with performance improvement over time. 

Using data, analytics, and automation, you may increase process agility to reduce revenue leakage and give patients a better financial experience. 

A value-based RCM model has three gaps that can be filled by implementing an innovative RCM solution. Below we will discuss them in detail: 

1. Use Consumer Information to Assist Patients in Making Wise Decisions  

Patients’ lack of knowledge regarding the price of their therapy is a significant factor in claims being rejected. Others are still determining if they have the proper insurance. By giving them precise estimates and working with them to verify insurance coverage, you can assist your patients in weighing their financial options.  

Consumer data can enhance this process by providing you with details on your patient’s social identity, medical history, insurance eligibility, coverage status, and likelihood to pay. You will enhance patient payment experiences and lower revenue leakage with a cloud-based revenue cycle management (RCM) solution. 

2. Analyze Your Data to Identify Gaps in Revenue Cycle Management 

High-performing health systems frequently use advanced healthcare data analytics tool anticipate potential bottlenecks, errors, and denials so they may quickly address them and maintain patient and executive satisfaction.  

For instance, you can classify your patients based on their financial responsibility and ability to pay by using analytics to understand them better. It allows you to concentrate on your collection efforts more successfully and gives you the knowledge you need to guide patients through the payment process with personalized reminders and pertinent information.  

Additionally, eliminating needless denials brought on by faulty or inaccurate patient data will immensely benefit from analytics. By identifying trends in denials, you can put checks and procedures in place to prevent them in the future. 

3. Set Up the Appropriate RCM Tools to Fill in the Gaps 

Making sure your patients know their financial obligations is the first step in reducing the growing revenue leakage between claims and collections. Your patients may easily access their information through a self-service patient portal at a time and location that works for them.  

They can make appointments, sign up for payment plans, and submit a charitable application. They will receive up to date, transparent, and precise price projections and information about their eligibility and coverage.When the financial process is transparent and hassle-free, patients are more likely to feel satisfied and less likely to shop for care. So, they are also better equipped to meet payment deadlines.

Additionally, you may monitor and manage each stage of your revenue cycle internally with data-driven automated tools. With integrated electronic health records (EHR) dashboards, web-based financial reporting, and timely warnings for the relevant teams, you may simplify the lives of doctors and management teams.  

Bottom Line 

This guide walked you through tips to close your revenue gap in a value-based world. If you want to increase your profitability, consider getting CareCloud’s revenue cycle management solution. Besides RCM, we also offer other advanced health IT solutions that can help you scale and stay on top of your practice.