Revenue Cycle Management

The U.S. healthcare system is in the midst of a major reformation. This begins with a fundamental restructuring of payment policies and delivery systems in order to put patients' interests first and support physicians and their care teams to deliver quality care.

In order to achieve an optimal U.S. healthcare system, providers must take a closer look at their foundation of revenue cycle management. Poor billing practices can result in financial loss and impede the organizations’ ability to deliver quality care. In fact, almost $750 billion of healthcare dollars are wasted every year. Streamlining core operational procedures helps providers remain financially viable and improves their ability to navigate cash flow bottlenecks caused by COVID-19. The future will inevitably present healthcare professionals and organizations with unexpected, yet manageable challenges.

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What is Revenue Cycle Management?

Revenue cycle management (RCM) utilizes medical billing software to track patient care from appointment scheduling to the final payment of a balance. RCM unifies the business and clinical sides of healthcare by connecting administrative data with the treatment a patient receives and their health history.

The front-end of the RCM process typically covers registration, financial clearance, pricing and compliance. The middle part of the process includes charge capture, documentation, medical coding, case management and review. The tail-end of the RCM process incorporates a wide array of billing activities, including:

  • Claims processing
  • Contract management
  • Denials management

It is important to remember that all steps within this process are intertwined. For example, if errors occur in the scheduling process, this will negatively impact claims processing and likely result in a denial. Healthcare organizations should focus their attention on ensuring that claims submissions are cleansed to avoid a resource-intensive appeals process.

Without revenue cycle management, healthcare providers would not be able to generate enough revenue to stay in business. The benefits of RCM include:

  • Seamless integration with EHRs (electronic health records)
  • Saves time and costs due to process automation
  • Allows patients to view and pay bills online
  • Reduces denied claims and resubmissions
  • Tracks each session to ensure the delivery of safe and consistent care


Challenges Within Revenue Cycle Management

Revenue cycles are complex and longstanding. It begins when the patient makes an appointment with a clinician and ends with a successful payment transaction. However, there are many opportunities for unverified insurance claims, inefficient charge capturing, a lag in patient access controls and billing and collection errors to derail your financial health.


Unverified Insurance Claims

An insurance claim is a formal request to an insurance company for coverage or compensation for a policy event. Providers must verify a patient’s insurance eligibility before receiving any care. Failing to do so could leave organizations with an unpaid claim by the insurance company or a patient unable to pay their bill promptly, resulting in a disorderly billing experience.


Inefficient Charge Capturing

Managing charge capture and securing an accurate charge description act as the beginning of a provider relationship for billing patients and payers. When successfully streamlined, this activity serves as the foundation of an efficient billing cycle. Providers must regularly update pricing for services while also billing in accordance with the charging and billing guidance provided by payers. Without the correct document training for medical billing professionals, the accuracy and authenticity of charges accrued become a risk.

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Lag in Patient Access Controls

The lack of control over patient registration is a major risk area for providers in 2020. If patient information is inaccurately collected, false billing claims could be made, resulting in a negative patient experience and inefficient information processing for the organization. Providers require a solid strategy and ample training to minimize the risk of a billing issue.


Billing and Collection Errors

There are many moving parts throughout the billing and collections process and the smallest inefficiency can lead to costly rework, denials and lost reimbursement. Preventative medical errors continue to persist, with 86% of the mistakes made in the healthcare industry falling under the administrative sector. Without the right tools, it can be nearly impossible to collect patient payments.

Another major RCM challenge for labs is the inability to track billed amount, expected reimbursement, and paid amount as part of the claims adjudication process. Accurate billing detail is very important when there is a discrepancy between paid and expected reimbursement from a payer because staff need a way to easily determine if there is a remaining balance to collect. Most RCM software fails to track at this level of detail, and the laboratory may not even be aware they have received a partial payment.


Intalere Solutions For Revenue Cycle Management

Intalere offers performance solutions to support the financial health of your organization. We empower healthcare providers to advance and elevate their financial performance capabilities through managed solutions including RPA, Priority Healthcare Payments, Insurance Services and REVolution Outsourced Billing/Collection and Consulting Services.


Robotic Process Automation (RPA)

Healthcare organizations are constantly seeking to reduce costs and increase operational efficiencies. Managing inventory, supporting the digitization of patient files, optimizing appointment scheduling and executing billing and claims processing can all be streamlined with the assistance of Intalere’s Robotic Process Automation (RPA).

RPA combines artificial intelligence and other advanced technologies to deliver a holistic solution that streamlines workflows. The software matches the repetitive processes and actions of a human interacting within digital systems. The project is typically completed within six weeks and delivers direct profitability back into organizations and helps staff:

  • Improve accuracy and control
  • Increase speed and productivity
  • Free up staff time to focus on patients
  • Enhance existing technology like EMR
  • Quickly realize ROI with low initial investment

Video: How Robots Can Make Your Processes Smarter


Priority Healthcare Payments

To cut expenses, improve cash flow and grow margins, implement payment processing solutions that can pay dividends almost immediately. These solutions can lower overall costs for merchant services and payment processing by up to 50% – while accelerating payments – with increases in collections in 30 days. Most importantly, they simplify payments so providers can focus on patients.

Intalere’s Priority Healthcare Payments enables healthcare provider organizations to optimize payment acceptance and payment remittance while driving significant savings and revenue. Benefits of Priority Healthcare Payments include:

  • Improve accuracy and control
  • Increase speed and productivity
  • Free up staff time to focus on patients
  • Enhance existing technology like EMR
  • Quickly realize ROI with low initial investment

Podcast: Cash Acceleration Solutions to Mitigate Financial Challenges During and After the COVID-19 Pandemic


Insurance Services

Additionally, another area of cost reduction that is often overlooked is insurance coverage. In many cases, an organization’s current annual insurance spend can be reviewed to help find immediate savings. These savings go directly to the bottom line and can be the difference in maintaining key personnel or having to let them go.

Intalere Insurance Services uses an intelligent aggregated model to group healthcare organizations into a large pool, allowing organizations to achieve greater purchasing strength and long-term stability with their employee benefits. The solution reduces costs while enhancing the security and coverage of the organization and its employees. Insurance services enable organizations to secure low-cost benefits within a variety of areas, including:


REVolution Lab and Radiology

Outpatient services generate substantial revenue for healthcare provider organizations. Lab and Radiology, in particular, can still be very profitable despite healthcare reform. But the nuances of lab and rad claims coupled with the amount of resources needed to collect optimally on these high volume, low dollar claims, can leave a substantial amount of cash that goes uncollected. Also, the financially devastating effects of the Protecting Access to Medicare Act (PAMA) on Outpatient Lab and Radiology reimbursement creates an even greater need to ensure that those claims are reimbursed in a timely fashion and in accordance with the provider’s contracted payer rates.

Intalere’s REVolution is achieving a 10% or greater increase in revenue for our client’s laboratory and radiology departments.

REVolution utilizes over 560 experts to provide outsourced revenue cycle management and Operational Improvement & Process Redesign Consulting services to healthcare provider organizations by helping them collect more of the cash they have earned in a timely fashion.

The benefits of REVolution include:

  • Options to pay immediately, online or with a mobile device using a credit or debit card
  • Gain efficiency, earn rebates and cut costs with automation tools
  • Reduce merchant service and ACH processing fees on patient payments
  • Executive and physician accommodations
  • Population health management
  • Integrated healthcare strategies
  • Data warehousing

An Optimized Future With Intalere

Medical providers are facing unprecedented times with strong headwinds of financial distress. The lack of elective procedures and closure of offices have left providers in financial stress that will take a long time to recover from. The need for immediate financial relief and optimized revenue cycle management processes is real and timely.

After uncovering challenges that act as blockers to organizational efficiency, resilient healthcare organizations must shift organizational mindsets, build a foundation of trust amongst staff, and navigate financial uncertainties. Intalere offers transformational, strategic revenue solutions that align with the overall goals of your organization and help in improving efficiency, maximizing financial value, and enhancing providers’ ability to offer the highest quality patient care.

To learn how Intalere’s solutions can improve the health of your organization, contact us today.

  • Free up resources to focus on higher dollar claims
  • Ensure all lab and radiology claims are paid at the contracted rate
  • Improve reimbursement revenue by at least 10%
  • Perform root cause analysis of denials to prevent future denials and speed the time to payment
  • A Cash Acceleration program to help you work aging claims that may have been neglected as a result of the staffing disruption during COVID-19

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