Managing revenue cycle in consumer-based healthcare

by John R. Fischer, Senior Reporter | July 18, 2022
Business Affairs
From the July 2022 issue of HealthCare Business News magazine

Choosing the right partner
Changes in regulatory requirements have forced providers to adapt their processes. For instance, value-based care has them now factoring in readmission rates, comorbidities and social determinants. And the hospital price transparency rule has them publishing prices for procedures on their sites to give patients a more informed healthcare shopping experience.

As a result, more are turning to outsourcing companies who are made up of experts with specialized know-how about these tasks and how best to facilitate them. Outsourcing also potentially enables providers to focus more on patients, scale operations, and bring in extra staff while saving on costs.

The downside is a loss of control and portability, according to Williams. “If you're outsourcing your revenue cycle, you've outsourced your labor on that too. So to be portable, meaning that if you want to make a change or decision within that partnership, there is going to be a lot of friction if you want to change from one outsourcer to another. If you insource, you're more portable and can more freely make decisions about how your experience is changing because you're in control of it.”

Many factors must be considered when deciding between in-house and outsourcing, including the type of provider, patient demographics, and infrastructure and resources. If an organization outsources, they must ask the right questions to find the vendor best suited for their needs. A good RCM partner, for example, should understand the workflow and consult with the provider about what experience their patients want, according to Sandy Coffta, vice president of client services for Healthcare Administrative Partners.

She says that providers should look for a company with credentialing and a robust charge reconciliation process that captures every service carried out. “With a good RCM company, you should have a good level of communication and serviceability to make you feel the same comfort level you would if billing were in-house.”

Investing in the right technology
In March 2022, Northwell Health, the largest care provider in New York State, signed a 10-year agreement with Clinithink to use its CLiX revenue solution to integrate natural language processing into its RCM operations. These automated capabilities can help it process millions of documents in hours instead of days and extend revenue cycle review without increasing staff costs.

As patient volumes continue to increase, solutions like this will continue to become more desirable to help process growing numbers of claims more quickly and accurately, as well as automate manual tasks. “Physicians should spend 80% of their time on the 20% of the tasks that require their full attention; the rest can be automated,” said Joey Cavanaugh, chief operations officer at Zotec Partners. “This paves the way for more in-depth and meaningful patient-doctor interactions, and it’s a significant asset for combating physician burnout.”

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