Healthcare�s Growing Need for Revenue Cycle Management (RCM)

June 2, 2009

As healthcare professionals struggle through the same economic restraints as the rest of the country, the need for a more dynamic, more reliable form of patient payment is growing exponentially.

As healthcare professionals struggle through the same economic restraints as the rest of the country, the need for a more dynamic, more reliable form of patient payment is growing exponentially. The trend towards consumer driven healthcare (CDH) continues to move upwards, with consumer out-of-pocket medical costs rising from $146.3 billion to $249.4 billion over the last decade. The Centers for Medicare and Medicaid Services (CMS) project that number will reach $440.8 billion by 2016. (National Health Expenditure Projection, 2006-2016, Centers for Medicare and Medicaid Services, 2006.) Uncompensated care nationwide increased 44% between 2000 and 2006, moving from $21.6 billion to $31.2 billion over the six year span (American Hospital Association, Health Forum, AHA Annual Survey Data, 1980-2006).

Providers who have not adopted new best practices are only collecting 50-60% of co-payments on average. With co-payments accounting for around 20% of the typical physician practice’s total revenue, bad collection strategies are costing providers dearly. The top 15 most common billing errors alone cost providers $327 million annually. How can providers guarantee they are following best practices, thereby decreasing revenue lost by delinquent payments and billing errors?

In this fragile environment, revenue cycle management (RCM) is a flexible, viable solution for outdated forms of payment request. As healthcare trends continue moving towards computerization, RCM software tailors payment solutions to the healthcare sphere by automating aspects of eligibility verification, claims management, electronic remittance advice, patient statements, credit/debit card processing, check processing, cash drawer, e-commerce capabilities and lockbox services.

A comprehensive suite of RCM tools can facilitate a quick, reliable integration of best practices into any healthcare provider platform, creating a better relationship between providers and patients. What are these best practices, and how can an RCM help healthcare providers follow them more strictly?

Multiple Payment Options

The face of bill payments is changing, according to the American Banker’s Association. From 2001-05, the amount of consumers using online bill pay rose by 16 percent, while consumers now claim one-third of in-store purchases are made with a debit card.

Failing to ask patients for payment at the time of service and offering patients too few payment options are common costly mistakes made by providers. Mandating payment has been shown to increase up-front collections by as much as 65%.

Offering patients a variety of ways to pay guarantees increased convenience, which in turn makes delinquent patient payment much less likely and greatly increases the speed with which payments are received. Most RCM suites are equipped with tools to speed check processing, monitor cash control, simplify credit card processing, and schedule payment plans for patients in more delicate financial situations. RCM suites can handle e-commerce transaction management, an extremely powerful and convenient tool for revenue collection.

Patient Education

Having a firm payment policy is just as beneficial for the provider as it is for the actual patient. A steadfast policy is much simpler to outline for patients and helps them understand responsibilities before they begin treatment. By implementing an RCM platform, providers automatically present a more structured payment program using the tools the software provides.

Eligibility and Benefits Verification

Insurance cards do not always represent accurate co-pay information. Outdated cards can misrepresent the actual payment due, confusing patients and staff alike. Also, verification processes can include numerous phone calls and paper clutter, wasting time, money, and resources.

RCM software bridges communication between the provider and the insurance company, often facilitating very quick turn-arounds through real-time information exchange. Electronic communication eliminates the costs associated with paper processing and mailing. Automated filing ensures staff attention will be focused on tasks that require more thorough consideration. These processes generally occur in real-time (or promptly) and allow the provider to edit and resubmit claims with ease.

Receipt Issue for Payments

Issuing receipts is a highly effective way to keep track of cash transactions. A paper trail discourages theft and fraud among employees, which costs US businesses over $652 billion annually, and contributes to better client awareness and satisfaction. Most RCMs offer options to print your own receipt directly, facilitating a safe and simple record-keeping process for cash transactions.

Simple, Effective Patient Statements

The simpler it is for patients to ascertain which fees correspond to which services, the more likely patients will respond quickly and efficiently. A recent HFMA study concluded these findings, with one provider reporting that consumer-friendly billing decreased billing question calls by 37 percent.

Many RCMs function with built-in transcription services, sometimes through partnerships with outside vendors. Organizing statements using a clear and effective template is a simple avenue to reducing patient discrepancies with payments due, saving staff time and the hassle of patients who simply choose not to pay fees because they do not understand what they are being charged for.

Jim Lacy is the Chief Financial Officer of ZirMed Inc and can be reached at jim.lacy@zirmed.com.