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Tuesday July 20, 2021  |  Noel Ogle, Vice President, MEDHOST Business Services at MEDHOST

Is Your Revenue Cycle Springing Leaks?

Is your revenue cycle springing a leak EHR

The community hospital plays a crucial dual role for the population it serves.

In addition to acting as centers for accessible health, community hospitals provide access to well-paid, skilled jobs and are a factor in attracting businesses to their area.

While the pandemic confirmed community hospitals’ critical role in patient care, at the same time, it often stressed economic viability. Under such taxing circumstances, it became even more essential to ensure community hospitals captured every dollar of revenue. Even still, on the downward slope of the pandemic, collecting complete and accurate payments remains an ongoing challenge for many facilities.

When payments and profitability are consistently below standards, one of the first places community hospitals should look is their revenue cycle management (RCM) process. For community hospitals already short on resources, it can be challenging to pinpoint RCM areas that need the most attention. In these cases, help from a third party is a practical solution to identifying and resolving potential RCM issues.

Common Community Hospital RCM Issues

Billing regulations and reimbursement rates are constantly changing in healthcare. Often with change comes confusion. Confusion in your business office can easily lead to billing errors or ill-advised RCM shortcuts. It is also important to point out hospitals’ claims denial rates have increased over the past several years and denials have reached new highs. Some of the top reasons for claim rejections and denials is due to medical necessity, coding errors, and claims filed too late due to lack of patient information along with authorization to provide services.

RCM issues spanning from contract management to self-pay patient collections can lead to:

  • Revenue loss
  • Service cuts
  • Denied and aging claims
  • Staff strain
  • Patient dissatisfaction

Significant losses can accumulate over time, and flawed processes become entrenched.

In addition, RCM processors are highly skilled professionals. Hiring experienced RCM staff is frequently problematic in non-urban or remote communities. Even if a community hospital can find suitable candidates, consistent patient billing issues can make hiring, training, retaining, and motivating those professionals even more difficult. Staffing issues can also lead to billing errors, which, when coupled with extended claim resolutions, result in patient dissatisfaction and a poor community image. 

Revenue Cycle Management Expertise Makes a Difference

A third-party RCM provider can support both the human and technology elements by acting as an extension of that hospital’s business office team. Bringing in additional expertise also helps your business staff:

  • Identify issues affecting profitability
  • Investigate and determine the cause of denials
  • Expedite and recover payer reimbursements
  • Monitor and report on ongoing RCM processes
  • Promote excellent customer service

MEDHOST as an RCM Partner

MEDHOST offers scalable RCM outsourcing solutions utilized by many of its community hospital customers. These services are managed by healthcare professionals with role-based RCM experience. Providing oversight and guidance, our team helps drive RCM best practices to optimize the hospital’s revenue cycle, which is essential to maintaining both operations and the hospital's critical role as a pillar to their community.

The MEDHOST Revenue Cycle Services staff collaborates closely with facility management. This collaboration and accountability include regular meetings for long-term planning, as well as providing weekly and monthly reports.

From staff workloads to accounts receivable, MEDHOST’s Revenue Cycle Services can make a significant difference in a community hospital’s ability to operate efficiently, maintain a positive community image, and improve the patient financial experience.

The added support gives financial operations stakeholders, like the business office manager and CFO, more autonomy. This level of self-sufficiency can be priceless in community hospital business offices. With a partner to help manage many of the day-to-day tasks of hospital billing operations, business office managers can find more time to train staff and improve customer service.

To learn more about MEDHOST Revenue Cycle Services and Solutions, email us at inquiries@MEDHOST.com or call 1.800.383.6278.

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