Hospitals and health systems continue to face persistent challenges from rising costs and labor shortages across clinical, administrative and revenue cycle teams. Recent news from Humana highlights that rising costs, “may persist for an extended period or, in some cases, permanently reset the baseline.” In addition, half of hospitals and health systems surveyed reported $100 million in Accounts Receivable (AR) for claims older than 6 months, amounting to $6.4 billion in delayed or unpaid claims, according to an AHA report.
From beginning to end, inefficiencies in the revenue cycle not only slow down workflows and cash collection, but they also have a big impact on patient experiences. In today’s healthcare landscape, finding efficient solutions becomes imperative for healthcare organizations seeking financial stability. Fully integrated Electronic Health Records (EHRs) that join and automate between clinical and financial processes can improve operational efficiency, streamline workflows, lower costs, reduce errors and the burden on staff by providing a consolidated view to easily monitor the revenue cycle process – all while improving patient care – to revolutionize revenue cycle management (RCM) practices and bolster hospitals’ financial health.
Improving inefficient workflows
For many organizations, the clinical EHR is separate from the (RCM) system, creating disjointed processes and increasing manual tasks for revenue cycle teams. It’s common for revenue cycle staff to rely on different systems to check patient eligibility, review patient chart information and confirm payer contract details. The reliance on third-party tools results in inefficient workflows that require RCM staff to use multiple systems with multiple user interfaces, which hinders efficiency and increases the risk of errors. In addition, a streamlined and consistent process within revenue cycle reduces the confusion and frustration for users who perform multiple related revenue cycle functions each and every day.
Integrated EHRs create a seamless process. For example, data from third parties, such as eligibility data and coding data can be automatically incorporated into the system. With well-integrated data, a unified framework and consistent user experience, the EHR can minimize manual interventions, consolidate diverse workflows, and ensure a consistent user experience across the revenue cycle.
Taking advantage of automation
Automation can significantly improve efficiency in revenue cycle operations. By seamlessly integrating clinical and financial information, the EHR can reduce manual data entry and reviews. For example, automation can make charge capture faster and more accurate to prevent revenue leakage. Instead of relying on clinical end users to manually select charges based on orders or procedures, EHRs can automate the charge based on the clinical documentation itself. This saves time for the end user and reduces revenue leakage. In addition, automated processes can efficiently complete outpatient coding, make charge or claim adjustments based on payer rules, and enter data from third-party sources, which significantly reduces the burden on staff while enhancing accuracy and compliance.
Putting deep data to work
Data-driven insights are indispensable for optimizing revenue cycle performance. Integrated EHRs can provide actionable intelligence that gives revenue cycle leaders the insight they need to manage key metrics, track trends, identify areas for improvement, and free up bottlenecks. Metrics such as cost to collect, days in AR and clean claim rate are critical to optimizing operations. Equally important is the ability to drill down into the details to analyze performance, such as top denial reasons and the most common edits that are slowing down billing. EHR-driven analytics can equip healthcare providers with data to drive operational efficiency and financial success.
Creating a convenient patient experience
Modern consumerism has raised the bar for healthcare providers to offer patients a convenient experience from registration through clinical care and payment. In recent years, patient payments have become a large percentage of overall hospital revenue. Healthcare organizations need to create a seamless experience that enables patients to schedule their appointments, fill out forms and pay their bills. An integrated EHR can eliminate the disjointed steps and create a clear and transparent process for patients that speeds up patient payments and improves patient satisfaction through functions such as text-to-pay reminders and patient estimates.
Fundamental considerations for RCM leaders
When evaluating RCM solutions, it’s important to consider the full picture of the impact that integration can have on the financial performance of the organization. Consolidation within a single, integrated EHR platform improves efficiency while reducing the costs and workforce burden associated with dependence on multiple vendors. Automation streamlines processes to alleviate staffing challenges and allow staff to focus on the most valuable activities. Strong analytics capabilities facilitate data-driven decision-making to continuously optimize operations. Lastly, the integration of patient-facing tools empowers patients to engage more actively in their own care and payment, ultimately improving revenue capture and patient satisfaction.
Paving the way for patient-centric RCM
In an era marked by economic uncertainties, EHRs can play just as important a role in RCM as they do in clinical patient care. By embracing integration of clinical, administrative and financial processes within the EHR, healthcare providers can navigate financial challenges more effectively while delivering superior patient care and financial experiences. With integration, automation, analytics, and patient experience at the forefront, EHRs pave the way for a more efficient, transparent, and patient-centric approach to RCM.
About Sandra Johnson
As Senior Vice President of Client Services at CliniComp, Sandra Johnson is responsible for delivering healthcare IT solutions and managing the customer experience to ensure CliniComp’s technology is continuously evolving to meet the changing needs within the healthcare community. Sandra oversees all aspects of the customer lifecycle including account & project management, application support, clinical services, cybersecurity, and learning & development for CliniComp’s global customer base.
