The new fiscal year in the U.S. healthcare market is undoubtedly very challenging. Considering the year 2016—a year for the U.S. presidential election to be held — the focus is to build a more streamlined healthcare system. It is slated to usher in a new phase in the U.S. healthcare system.
Revenue cycle management, an imperative administrative part of healthcare services, has to be managed more efficiently through a proper delivery model in 2016. Healthcare finance will continue to be an increasingly important factor. The guiding philosophy will be how to deliver quality care in a more cost-efficient way.
The entire revenue cycle management process is undergoing a rapid change due to the Affordable Care Act. The year 2016 is estimated to witness the rise of value-based reimbursement, and the proliferation of high-deductible healthcare plans.
According to MicroMarketMonitor report, the revenue cycle management market was valued at nearly $18.3 billion in 2014, and it is expected to soar to $32.2 billion by 2019.
To increase control of revenue cycle management in healthcare, some past and future metrics are to be observed to make it more streamlined.
The past metrics are:
♦ Did you face any collection issues in 2015?
♦ What were the rates of claims rejection and denial in 2015?
♦ What was the collection rate on an average?
♦ How did you handle eligibility and authorization verification on the insurance side?
♦ What caused delays in the cash flow?
By identifying the weak metrics, you can make your revenue cycle management process more efficient in 2016. Some of the benefits you’d enjoy include:
♦ Improvement in communication techniques would make the RCM process more effective
♦ Expert intervention on medical coding and impact of ICD-10 has to be analyzed through the control of RCM. Although accurate coding has always played a striking role in optimizing revenue, it has become even more important with the October 2015 ICD-10 transition
♦Assessing performance and responding to existing deficits. It is important for all revenue cycle functions and very beneficial in the area of denials
♦ To implement technology relevant to tracks denials that identifies trends and patterns. This will help healthcare service providers to correct processes and avoid future denials, and reduce cost and time associated with claim reworks
♦ Revenue cycle process is not ‘once and done’ work; it needs constant analysis. The involved personnel should be very attentive and have to remain focused on achieving an uninterrupted flow of revenue.