The healthcare industry is perhaps one that has been an eager adopter of technology. Some of the most advanced technology solutions are a part of the everyday hospital environment. We have also witnessed technology proliferation, not just in diagnostics and surgery but also in healthcare systems, to improve patient outcomes and drive elevated patient experiences. As the patient becomes the consumer of healthcare, healthcare companies have to ensure that they provide the best care to the patients while making the right decisions that also secure their financial health.

Revenue management systems have thus found their place in the healthcare industry and have been a critical enabler of better healthcare management practices.

However, given the complex revenue landscape, healthcare companies must work with an F&A partner who comes with deep domain expertise. Here are a few reasons why:

A Complex Environment

As in every industry, finance and accounting play a big role in healthcare as well. Correct identification, management, and collection of patient revenues become essential since these keep the operational and administrative functions operating smoothly. Insurance and claim settlements, a tight regulatory landscape, frequently evolving compliance mandates that extend beyond patient care make the revenue environment complex.

Augmenting revenue management with the help of F&A experts with deep domain expertise becomes essential to make sure that all the complexities of this landscape. Doing this ensures that all these complexities are adequately captured and the organization remains on the right side of the law by having the right, easily auditable process.

Navigating Billing Complexities

Healthcare organizations need robust medical billing capabilities to drive good financial outcomes. However, reports suggest that almost 80% of medical bills contain errors. These billing errors usually emerge owing to incorrect inputs such as entering wrong diagnostic codes, incorrect CPT & ICD codes along with modifiers, number of units and service date, etc.

An F&A expert with domain expertise in healthcare is aware of the different challenges and the stakes at play that impact medical billing and lead to errors. Using their knowledge and experience, they can design robust pre-billing and post billing processes that account for the entire billing lifecycle – right from appointment scheduling to payment reconciliation.

While doing this they also ensure that important factors such as eligibility verification, proper authorizations, correct charge capturing, claims transmission, etc. along with denial management, submitting and following up on claims, and other such essential processes are well-defined. Doing this helps to bring down costs and improves collections using the right workflows and processes.

Crossing the Claims Conundrum

Healthcare companies need to accelerate their claims processing capabilities since a large amount of hospital billing is dependent on hospital remittance. However, insurance claims processes can be tedious and complex. It can also take time for the healthcare organization to get its due in time thereby impacting the revenue management function.

Claims processing and management thus have to be an error-free process that also allows for close monitoring. From verification, authentication to reimbursements, all the variables that contribute to this process have to be organically organized and systematically connected.

Designing robust claims processing and management processes that easily capture all the essential touchpoints of the claims process comes from domain expertise. Such F&A experts can not only help in streamlining the claims process but also make sure that the accuracy and legitimacy of data are maintained throughout to prevent delays and denials of submitted claims.

Account Receivables Management Challenge

Healthcare organizations need clear insights into their accounts receivable workflows and processes to make account receivable management easier and more effective while being resource and time-efficient. For this, they need a workflow solution that helps them prioritize the AR management and liquidation processes while providing transparency into collection efforts and cash flow.

These insights make the AR management process more accurate as it also helps organizations identify opportunities for cash flow improvements.

Those F&A partners who have the domain knowledge of the complicated healthcare ecosystem can design adequate workflows and can even suggest customizations of the AR management workflows to suit specific needs. While they do this, it is also imperative to take care of elements such as data protection while providing assured accuracy, swift turnaround time, and driving assured savings by giving organizations insights into where they can lower internal costs, increase collections, and improve cash flow.

Designing a Robust Audit Process

Accounting and finance in the healthcare environment are as exhausting as it is confusing. With medical bills filled with special terms, complex medical coding at work, diagnostic processes having their alphanumeric codes, etc. audits become challenging.

Managing regulatory compliance also becomes essential to drive healthy audits. These organizations have to make sure that every program or law introduced is complied with immediately.

Tax optimization and management are even more challenging when organizations do not know which opportunities to leverage. Poor debt management and lack of accuracy into revenues further add to the auditing complexities.

Expertise in ICD-9 / ICD-10, CPT coding, and HCPCS codes across various specialities as well as AAPC certification for both coding and audits become helpful to design robust audit processes. With the right domain expertise, F&A experts can then assist the healthcare organizations to account for the right variables and help them manage the audit nightmare with ease.

In Conclusion

As the compliance and regulatory landscape becomes a minefield and competition in the healthcare sector intensifies, organizations have to look at optimizing their revenue management capabilities.

Only with the help of F&A experts with the right domain knowledge healthcare companies can create the right revenue management solution that connects the disparate departments of the organization, removes silos, facilitates easy and yet secure data movement. Using their industry knowledge, these experts can help healthcare organizations move beyond P&L’s and make the entire revenue management more streamlined, efficient, and compliant.

Connect with us, and we can help you with next-generation F&A solutions by applying a powerful mix of industry insights, innovative processes, and analytics.