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What Are Your Revenue Cycle Risk Areas?

January 17, 2019

For healthcare providers to treat and cure patients, they must first diagnose the source of the troublesome symptoms. The same goes for effectively managing and eliminating risk within the vital revenue cycle. Healthcare businesses have to proactively identify key vulnerabilities. Failing to do so can potentially weaken or destroy a practice. But uncover those often-hidden threats and it’s possible to strengthen revenues and achieve healthier margins.

Eligibility & Benefits Verification

Unless verification is prompt and accurate, it’s a huge revenue cycle risk. Coding may be outdated, leading to a loss of full reimbursement. Manual coding also slows the revenue cycle while increasing human error and staffing overhead. Controlling such costs is more important than ever, as margins have shrunk by almost 40 percent within the past few years. Another common pitfall is pursuance of payment from a patient when the insurer is actually responsible. That creates patient friction and elevated risk of losing them to a competitor.

All of those challenges can be solved with the right automated payment processing platform. Insurance eligibility verification, coding updates and inputs, invoicing, and tracking of payments can be centralized and automated. Verification can be performed in real-time, or in convenient batches. Co-pays and deductibles can be precisely calculated, even before the patient shows up for their appointment.

Payments and Collections

Survey data reveals that 73 percent of providers do not receive payments for 30 days or more. That postpones deposits that are essential to reliable cash flow. But it also helps to delay the identification of potential delinquent payments that may require actionable collection attention.

When payments are routinely more than 30 days late, that hampers account reconciliation and conclusive financial reporting, too. But 79 percent of medical patients still receive paper billing statements via “snail mail.” Meanwhile, more than 85 percent of providers still get paid by paper check. Those issues by can eliminated by simply taking advantage of a secure digital payment system with a patient-friendly, HIPAA-compliant, online payment portal.

Patient Engagement

To minimize revenue cycle risk while maximizing patient retention, it’s necessary to engage patients on their own terms. Patients are shouldering much more responsibility for payments and co-payments. They are also enjoying greater freedom to make healthcare decisions. They expect a retail type payment experience, with online convenience. They also want to review billing statements, schedule appointments, view medical records, and get questions answered online.

Value-based care is also key component of patient engagement, and that makes swift, granular, customizable reporting increasingly essential. Value-based contracts are commonplace, and without the ability to monitor and measure quality, providers can lose valuable incentives. Worse still, they can be subject to stiff penalties that might otherwise be avoided through insightful analysis and reporting. Fortunately, today’s payment technologies can meet the consumer expectations of patients as well as the needs of providers. They help to reduce appointment wait times and no-shows and the burden on front-office staff. They also accommodate patient-centered payment plans, and make detailed reporting and analysis fast, factual, and easy.

Revenue cycle risks are pervasive and pose a very real threat. But solutions that can eradicate the threats while strengthening revenues are available, cost-effective, and easy to deploy.