Every thriving company in any industry relies on generating revenue to cover expenses. Unfortunately, many hospitals and clinics have a difficult time collecting reimbursements in a timely manner, which may harm their quality of care. The most common reason for these inefficiencies is due to human error. Many healthcare organizations still rely on slow manual processes to manage their revenue.
Defining Healthcare Revenue Cycle Management
Healthcare revenue cycle management describes the complete process of managing reimbursements and payment processing.
Pre-registration is necessary for gathering accurate details on patients’ medical history, insurance coverage, and financial obligations.
Insurance Eligibility Issues
Keeping a direct line with insurance carriers is vital. Overlooking certain steps in the process after submission can potentially lead to denied applications.
Manual processes are one of the main culprits why healthcare organizations are incapable of effectively collecting payments.
The problems generated by manual processes are made worse by the fact that insurance providers make constant changes to their terms. As a result, prior authorization and candidate screening are time-consuming.
Benefits of a Revenue Management Tool
Without proper revenue management processes, hospitals and clinics are unable to offer high-quality care and maintain their financial liquidity at the same time. Let’s go over some of the most important advantages of using rules-based revenue management software solutions.
Steady Revenue Stream
Generating a consistent revenue stream is probably one of the most meaningful benefits of revenue cycle management software. Healthcare organizations can enjoy a higher level of liquidity which translates into better patient care.
Revenue management tools increase revenue cycle visibility, which means that the staff can analyze revenue slumps and flag processes that need to be improved.
Revenue cycle software tools provide a user-friendly solution to both doctors and administrative staff, which helps in driving revenue for healthcare organizations.
Handling Denied Claims
When a claim is denied, there’s still a chance to make adjustments in order to get it accepted. However, time is of the essence in these situations.
Rules engines automate repetitive and lengthy tasks — such as authorizations or reviewing a claim’s status.
As a result, the likelihood of a claim being denied due to human error is eliminated.
Establish Coverage Eligibility
Software tools powered by business rules can instantly carry out coverage eligibility analyses. As a result, healthcare organizations can enjoy a dramatic reduction in time spent on repetitive and mundane administrative tasks.
Business Rules Engines in Revenue Cycle Management
To ensure that patients receive the best treatment possible while receiving reimbursement for their services, healthcare organizations should turn to automated revenue management solutions that are powered by business rules engines.
A business rules engine cuts down on the amount of time it takes for a medical facility to complete eligibility screening, which means that the administrative staff can concentrate on other important tasks, such as payment collections.
Optimizing Revenue Cycle Management Solution with Business Rules Engine
A business rules engine optimizes mission-critical tasks such as managing patient financial records by interacting with other systems.
Rules engines help healthcare providers automate tasks like candidate insurance eligibility screening, appointment reminders, and to streamline communication with insurance carriers about reimbursement problems.
Properly configured automation enables medical facilities to redirect valuable resources into offering the best patient care possible.