You don’t just suddenly end up with a fully optimized revenue cycle management (RCM) program. Firstly, RCM is a complex business interaction with patients that entails many touchpoints. It has 17 different steps, starting from patient scheduling, ending with payment reconciliation, and needing all processes in all steps to work in unison for complete optimization.
That’s inside your organization - let’s step out for a bit to look at the industry as a whole, a rapidly evolving one with constant regulatory changes that your RCM simply has to keep up with. Then, let’s step out even further, outside the industry, where the attackers are. Here’s an alarming fact: healthcare data breaches are the costliest compared to other sectors.
Therefore, there are many things to consider when trying to optimize your RCM program. Yet, data is one thing we can always count on to shape our strategies. To measure your RCM program's success, KPIs are your best bet, and you can read all about that here. This blog looks at prevalent statistics in the healthcare industry and how you can use them to craft your RCM strategy.
What this means: Some of them will move to other plans, but a troubling trend here is that a steady increase in uncompensated care costs throughout 2023 will likely continue this year. That means it is essential for your RCM plan to be on top of coverages and deadlines to ensure your denial rates stay low with all these providers.
What this means: So, considering the rise in uncompensated care costs, you will be dealing more with real people with real financial woes, coming off an adamant time with the pandemic. It is essential to empathize with their problems because while they may have difficulty paying at that point, you still want their patronage in the long run. Therefore, a sensitive customer service approach is a crucial facet to add to your RCM strategy.
What this means: Firstly, your RCM program will be housing a lot of sensitive, and to attackers, potentially lucrative PHI. Entities like UnitedHealth, Kaiser Foundation, and MCNA Dental have reported breaches this year, and it is important to fortify your RCM program (and any third-party vendors you may use to operate it) with the best-in-class data security tools like DLP and zero trust.
What this means: They’re uncomfortable with robots interfering in their treatment. Yet, regarding your RCM strategy, emerging technologies like AI, ML & robotic process automation could have a transformative effect. For example, AI & ML could be used to conduct predictive analysis on your claims process to keep denials to an absolute minimum. The key to all automation is to do it in phases, so start by incorporating it into your more ‘rinse-and-repeat’ RCM tasks.
What this means: In an industry where payments are usually made after care is provided, you should try all you can to get the money before service or within 7 days of it. This can be achieved through different payment plans and digital payment modes. It all has to be built into your RCM to reduce your days in accounts receivable.
What this means is that you need to avoid simple human errors like not checking the patient information while filing the claim, not filing it within the deadline, or not planning according to the current coverage schemes. Our RCM solutions eradicate all these errors and guarantee denial rates of below 1%.
What this means: The RCM field is known to have more turnover than most, which makes it highly difficult to maintain an effective in-house team. In this scenario, you would be better off outsourcing your RCM operations to a partner that uses real, relevant data to determine their strategies.
Stop Guessing, Start Winning: Leverage Data-Driven Stats to Optimize Your RCM. Contact us here.