A revenue cycle is, as defined by the Healthcare Financial Management Association (HFMA), all administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue. In other words, Hospital Revenue Cycles refers to the entire life of a patient account from creation to payment.
The Revenue Cycle Management process begins when a patient schedules an appointment and it ends when the healthcare provider has accepted all payments. There are sometimes errors in Revenue Cycle Management and these errors can lead to the healthcare provider receiving delayed payments or no payment at all. Because the revenue cycle process is complex and subject to regulatory oversight, healthcare providers can turn over their Revenue Cycle Management to companies that handle this complex process 24/7 with specialized agents and proprietary technologies to manage healthcare provider revenue cycles. However, healthcare organizations can also improve their hospital revenue cycles in house by using appropriate software and also applying other steps listed below
Ways to Improve Hospital Revenue Cycles
Trend and Benchmark Your Healthcare Data: You cannot measure what you can’t manage and this is very true when it involves a revenue cycle and healthcare data.
When hospitals start trending and benchmarking their data, they’ll be able to identify areas to improve their revenue cycle.
The best way to trend data is to use an enterprise data warehouse (EDW). An EDW combines data from your disparate IT systems — clinical, financial, human resources, patient satisfaction scores, and more — and optimizes it for analysis. As healthcare organizations review the data, they’ll be able to use visualizations, which will help them better understand the results as they drill down and discover the root cause of certain trends. When trending, it is advised to look at both hospital and physician billing data for a full picture of the organization’s revenue cycle.
Use an Enterprise Data Warehouse to mine Healthcare Data: I already mentioned the use of an enterprise data warehouse in the point above. Well, an EDW is very important and can be used extensively to help a healthcare organization manage and take control of its revenue cycle. An EDW is a powerful solution that enables hospitals to mine their data, discover roadblocks, and determine how to improve. The management of healthcare organizations should get a good analyst to go behind the scenes and see what the data reveals — and then work to implement change in the organization. This process must be done in a positive atmosphere. With an EDW, experienced analysts, and a culture of improvement, this process was easy.
Constantly Ask Frontline Staff for Suggestions: Trending and mining data with an EDW is invaluable for gaining insights to improve your revenue cycle management. But don’t forget an equally important resource: your frontline staff. The frontline staff is the first point of contact a patient has with a healthcare organization. There are different contact points from when a patient calls to when they walk into the facility for the first time to even email exchanges. The frontline staff is an invaluable source of raw and authentic information of how patients and customers respond to the revenue system.
After you’ve identified a roadblock, consult your frontline staff for suggestions about the best way to solve the problem. Then, continually check back with them for additional suggestions. Reexamine your workflow on a periodic basis, and ask the following questions: What workarounds have you put in place? Are the workaround still needed?
What could you do to eliminate roadblocks and workarounds? Frontline staff have a lot of insight to share — and making them active participants in a culture of improvement helps to guarantee sustainable change.