Revenue Cycle challenges in this new decade

    Manoj Matai

    As entire nations encourage their populations to stay inside to avoid COVID-19, healthcare providers are more active than ever in response to the outbreak of the novel coronavirus. The current environment for revenue cycle management is laden with clinical and financial challenges.

    The Challenges

    Few challenges faced in revenue cycle today include:

    • Delay in payments by the payers
    • Increment in revenue cycle cost
    • High risk and business complexities
    • Unprecedented volumes

    Our Solutions

    We have implemented and complied with requirements such as coding for Telemedicine / Telehealth visits. Implementing relevant standards for commercial and medical payers and taking care of regulatory requirements like ensuring time is documented well in the note and a statement indicating the Telemedicine / Telehealth service was performed for that visit. There are other innovative solutions which we are implementing to stay ahead in these uncertain times.

    Medical coding

    Increased complexity of coding requirements by payers, including CMS, means that providers will need to be sure that clinical documentation is provided to support the applicable codes, and that any third-party services utilized are regularly monitored. It is important to impart ample knowledge and training to employees. Audits can be conducted to keep a health check on the quality.

    Billing and Collections

    Keeping the billing office running during an outbreak is key to keeping hospitals and practices open for patients requiring care. But this can be a challenge, especially for smaller organizations with limited cash on hand to respond to COVID-19 demands. Transparency in billing is necessary, billing staff should be trained and confident to answer questions about pricing over phone or in person.

    Patient Access

    Registration, scheduling and admission processes should be carefully implemented to minimize the risk for billing. We should agree on adapting estimation tools that will help the customers to know approximate billing cost at the time of admission. Patients should be given leverage on the modes of payments either electronic or hard cash.

    Denial Management

    It is critical to track, identify and effectively manage denials since there are patterns that require identification and mitigation. However, industry experts caution that 2020 will require an interdisciplinary approach to denial management among a practice’s departments in addition to the back office to keep the claims submission process running smoothly. It is important for us to track denial KPI’s and third party payer’s reimbursement. It is essential to automate the denial process while working on exception management and consistent data deep dives.

    JindalX Advantage

    JindalX can do an analysis of your billing and denials to find out insights that can help to ensure faster payments and reduced balance by up to 40%.

    Our best-in-class healthcare solutions simplify on-boarding of your revenue cycle management requirements so that you are not distracted from your patients and can continue to bring more smiles.