When a patient visits a doctor for medical services, revenue cycle management (RCM) begins. RCM is the process of managing financials through various billing software. Healthcare facilities use this process to track patients’ health records, from appointment scheduling to reimbursements. RCM ensures that payment collections from the patient and the payers are done accurately.
For healthcare facilities, financial stability is the key to success; if a practice is financially unstable, it will be difficult for them to provide services to the patients and gain patient trust in the long run. It is necessary for the practices to collect payments properly and gain financial stability to generate maximum revenue. As we said, revenue cycle management is the most important aspect of medical billing, and it is also the most crucial part of the process. Healthcare providers face many difficulties while managing RCM due to the intricacies of medical billing. Practices face many challenges while managing RCM. In today’s Blog, we will discuss the key challenges Healthcare practices are facing in Revenue cycle management in 2024.
Here are 5 Key Challenges in Revenue Cycle Management:
Ineffective Patient Collection Strategies
A huge challenge that medical practices face in RCM is patient collection. Practices have been seen struggling with collecting payments from patients most after providing services. The reason behind this is that patients usually can’t afford out-of-pocket charges due to increasing deductibles. Another reason for this is that practices do not follow proper strategies to manage patient collection and have inconsistent follow-ups with them. According to a 2017 report, about 68% of the patients did not pay their balance amounts, which is alarming for the practice. When revenue is not coming into the practice, practices are unable to continue their operations and provide services.
Increase in Claim Denials
A claims denial is a rejection of a submitted bill to the payer for the services provided to the patient. There are different categories of claim denial, such as Full denial, Partial denial, Irreversible, or appealable. Payers can reject a claim due to wrong or missing patient information, wrong documentation, Unbundling, Upcoading, Downcoadin, Wrong CPT Codes, or many other reasons.
According to the research, many payers reject almost 12 to 17 percent of the claims every day, which is a high rate. Healthcare practices fight with the payers for these denials for days, which increases their operational costs, consumes time, and occupies the staff.
That is why managing claims efficiently is vital for the practice to increase reimbursements and revenue.
HIPPA Compliance and Regulations
The medical industry is growing every day and keeps on updating its regulations and compliance. Following these regulations and complying with them is compulsory for the practices to ensure accuracy and patient satisfaction. Medical practices are seen as busy providing services to a huge number of patients, which is why when they deal with a large number of patients, they sometimes leave some compliance loopholes behind. This error might be small in scope, but it can cause big problems for practices like legal penalties and fraudulent allegations.
Practices must protect their patients’ information, Medical codes, Claim details, patient payment methods, worksheets, and medical history. They are also required to protect their passwords and limit login access to stay compliant. Practices must provide privacy and security to their patients to gain patient trust and keep up with the regulations.
Poor Communication with Payers and Patients
Patients usually do not understand the medical language, which is why when they receive a bill, they might think that the facility has overbilled them. Which eventually delays the payments and affects the revenue cycle management.
Every patient who receives services from a medical facility can not understand the intricate medical codes of the claims. That is why it is necessary for doctors to have clear communication with their patients and explain to them each and every charge they will have to pay out of their own pocket and what the insurance company will cover.
Challenges with In-house Billing and Staffing
Every day, a huge number of patients visit a healthcare facility for services, so the front desk staff confirms their eligibility to perform services. However, many facilities still face claim denials due to wrong eligibility verification. In that case, providers think that they are short on staff and need to hire new staff members. This only costs them extra money. Providers also face challenges with in-house billing due to a large number of claims that their in-house team cannot manage every day, which delays claim submissions. To overcome these issues, providers must arrange training for their in-house teams or hire new people to manage their billing. Which increases their operational costs.
Navigate the RCM Challenges with expert assistance in 2024
Challenges in revenue cycle management affect the overall productivity of the practice’s operations, patient satisfaction, and much more. Practices, in that case, must consider outsourcing a professional Revenue cycle management company with years of experience and expertise in the medical billing field. If you are one of those healthcare providers who are struggling to manage your RCM, you can consider Physicians Revenue Group, Inc. for assistance. They not only provide RCM services but also assist you with other services like Medical Billing services in the USA, Audit services, Credentialing services, etc. PRG has professionals who provide you with services and solutions that meet your practice needs.
Conclusion
Revenue Cycle management plays a big part in medical billing. Healthcare facilities providing medical services to patients often deal with challenges like payment collection, claim denials, Lack of communication with the patients, In-house billing issues, and much more. In today’s Blog, we have discussed the five most common challenges that almost every practice is facing. If you are struggling through any of those challenges, you should read this Blog and understand the reasons behind them and how you can overcome them.
