As health systems navigate revenue cycle complexities, tapping into the potential of the much-sought-after technologies like artificial intelligence (AI), business intelligence (BI), and robotic process automation (RPA) is no more a choice for them, but a necessity for survival. These technologies have become critical to revenue cycle management (RCM) to maintain financial integrity, adapt to changing payer policies, keep up with industry regulations, and uphold the commitment to patient care, all while following practices, starting from the front-end itself, that could keep denials at bay.
Optimize to thrive
The need for revenue cycle optimization is more than ever, as evidenced by the climbing rate of claim denials that are costing hospitals around $20 billion every year. The Healthcare Financial Management Association (HFMA) insights have revealed that process improvements can help prevent 90% of the denials, and 65% of the denials are never given a second chance through resubmission. This clearly highlights the growing burden of denials and the need for proactive measures to reduce them. Moreover, the Medical Group Management Association (MGMA) cannot emphasize enough on the need to understand denials to prevent them.
While it is encouraging to see providers intensifying their focus on mid-cycle and back-end functions of
Strengthen the front-end: The first line of defense
Since a lot happens before a patient’s clinical encounter and before the final claim reaches the payer for approval, front-end operations can have a huge role in preventing potential denials. Front-end functions like registration, eligibility verification, and prior authorization play a critical role in verifying coverage and patient details, estimating costs, streamlining claims, facilitating care delivery, and preventing denials that happen due to documentation errors and inaccurate verification. For instance, inaccurate patient details filled manually during registration may result in a denied claim, further impacting the cash flow of the health system. Thus, it is important for providers to focus on improving front-end efficiency to boost their clean claim rate and financial performance.
Strategize your way to RCM success
Needless to say, a big share of back-end denials is attributed to front-end inefficiencies, and optimizing functions at the front-end can well prevent these denials from happening in the first place. Here are the ways that can help providers up their front-end game.
Dive into technology fearlessly
For providers to ensure a seamless cash flow with a reduced denial rate, embracing a forward-looking approach to RCM is a must. This is particularly important when they are dealing with staff shortages and burnout and system…