CMS Spending Growth
21 Oct

RCM Transformation Needed

COVID-19 has no doubt re-shaped the way healthcare is conducted. From more telehealth visits to nurse only visits for vaccine administration, both physician office and hospital visits are not what they were two years ago. Which has all impacted the way the Revenue Cycle must be managed.

Hospitals have taken the biggest hit, with major changes to their payor mix. A shift from Commercial payors to more Medicaid (a reported 34 percent) and self-pay patients (a reported 22 percent), has affected overall cash. Likewise, with more self-pay patients, it is inevitable to see a rise in bad-debt and courtesy write offs as well (27 percent of hospitals reported an increase).

Another issue has been a reported 33 percent of hospitals stating an increase in denials has affected their overall cash flow. Loosely tied to the pandemic, many commercial payors have had ever-evolving changes to their policies to try to adapt to how patient care has been changing.

A new model is emerging that better correlates front end, clinical, and back end office areas to one another. Obtaining authorizations and accurate eligibility has never been more critical to reducing denials. Likewise, ensuring clinical documentation meets all necessary requirements to match billing records is key for additional documentation requests. Lastly, timely filing of appeals to these increased denials are key to ensuring a faster turn around of claim to cash.

Denials management is key to this solution. Ensuring your system is set up to record and track denials will help quickly identify any issues to help close any gaps in your practices or hospital’s performance. Likewise, weekly review of denials will help your teams stay on top of issues and ensure denials are worked timely and in full.

The key takeaway is that there is not much practices or hospitals can do to change their payor mix in this pandemic scenario. The best option is to ensure close monitoring of your front to back end services to ensure timely, clean claims to reduce the overall impact to your income.

Source: https://revcycleintelligence.com/news/hospital-revenue-cycle-transformation-needed-to-boost-performance

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Donna White

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