Top 3 Revenue cycle management challenges faced by hospitals

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Top 3 Revenue cycle management challenges faced
by hospitals

• The Revenue Cycle Management (RCM) of hospitals
  is vigorous and strives to progress every day.
  However, an array of hospitals bears the brunt of
  some common RCM problems. The pain points of RCM
  resurface in the hospital environment on a
  continuous basis and the challenges are
  characteristically similar everywhere billing
  and coding errors, IT slow down, weak or lacking
  financial policies, bad debts, denials, charge
  capture issues, A/Rs, and/or inexperienced staff.
  It is imperative for the management to oversee
  the RCM and work towards improving this cycle.
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• Top 3 revenue cycle management challenges
• Billing, coding, and collections errors
• Most times, millions of dollars are left on the
  table which is mainly due to billing and coding
  errors as the billing processes are not in place.
  More so, collections from patients become
  increasingly difficult once they have left the
  healthcare facility (patients end up leaving the
  hospital without paying their out-of-pocket costs
  or leave with debts behind).

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Top 3 Revenue cycle management challenges faced
by hospitals
Many hospitals do not have a quality assurance
process in place, which if implemented can check
the claims entry on a regular basis. Managing and
dealing with rejected and denied claims are a
necessity and such errors need to be eliminated.
Sometimes, due to rising costs, hospitals
(especially rural ones) do not have the capital
to invest in technology. As a result, they do not
have systems such as EHR, which hamper
the hospital billing and coding, hence lower
revenues and bad debts.   2. Staff Untrained
staff is a problem area for many hospitals. An
untrained staff member may not be able to gather
the apt patient demographic information, and
hence may not be able to create and collect an
insurance claim, leading to low revenues. Also,
data (customer information), if not verified
leads to a loss in revenues. Coders too need to
be aware of the latest ICD-10 codes in order to
avoid errors in billing. Billing efficiency is at
a risk with inexperienced and unqualified staff.
Some hospitals also lack staff trained in project
management and clinical documentation, or they
have disintegrated RCM teams leading to a lack of
communication and unproductive operations.
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Top 3 Revenue cycle management challenges faced
by hospitals
3. Policies Many hospitals do not have a
financial policy for employees and patients.
Employees must have knowledge in dealing with
denied claims. Patients must get their
information about collections, co-payments,
unpaid balances, or other payable agreements from
these financial policies. Hospitals are regularly
dealing with uninsured patients leading to poorer
revenues. Hospitals are under tremendous
pressure. With lowering reimbursements from
insurance providers, sustaining a cash flow is
absolutely vital. Hospitals need to scrutinize
and optimize RCM processes. Apart from billing
and coding management, areas such as ICD-10,
system integration, standards of clinical
documentation, and contract analysis, need to be
made proficient. For garnering higher revenues a
plan that takes care of front-end management to
billing and coding the claims, along with
dashboard reporting, needs to be established.