Challenges Surrounding Revenue Cycle Management in Specialty...

Challenges Surrounding Revenue Cycle Management in Specialty Healthcare

Healthcare Tech Outlook | Wednesday, November 17, 2021

To avoid situations where claims are not addressed owing to a lack of clarity on the standards, CFOs should collaborate with COOs and revenue cycle operations managers to create A/R and collections standard operating procedures.

FREMONT, CA: The healthcare business is already beginning to use robotic process automation and artificial intelligence to manage its revenue cycle in today's digital environment. The adoption of automated workflows has resulted in fewer errors, higher collections, and better overall profitability. Despite these developments, some Revenue Cycle Management (RCM) processes, particularly in specialty healthcare, continue to have gaps. This article discusses a few RCM difficulties in specialty healthcare and some tools and techniques for dealing with them.

Strong Prior Authorization Process

Prior authorization is how a physician obtains payer approval before providing any treatment to a patient. Prior authorization aids in cost containment and permits clinicians to give patients with evidence-based care. Prior authorizations are critical in specialty healthcare because doctors can devise a treatment plan that complies with the various payers' standards. As a result, outsourcing the prior authorization process to an RCM provider who knows specialty-specific prior authorization regulations will help organizations improve the clean claim rate, decrease denials, and increase reimbursements.

Precision Medical Coding

One of the most challenging aspects of revenue cycle management for a specialty healthcare provider is coding. The rapid growth of ICD-10 criteria for specialist healthcare necessitates coders being current on every facet of correct practices. Revenue leakage could be caused by a lack of understanding and improper coding. Outsourcing their specialized coding needs to an offshore revenue cycle management business will help them deal with payment issues caused by frequent changes in guidelines.

Managing Account Receivable (A/R) Diligently

While managing, the A/R benchmarks for the specific specialty must be followed. A dedicated staff of A/R and denial management experts can keep days in A/R under 30 days. By providing iterative feedback to coders and physicians based on claim rejections, the focus may be shifted to denial avoidance, and large backlogs can be avoided. To avoid situations where claims are not addressed owing to a lack of clarity on the standards, CFOs should collaborate with COOs and revenue cycle operations managers to create A/R and collections standard operating procedures.

Weekly Brief