The hospital revenue cycle has become even more complex in recent years due to several factors, including more complicated payer contracts and greater regulatory demand. It is now more important than ever for your hospital to boost revenue cycle performance to ensure financial viability as reimbursements dwindle and operating costs grow.
How can your hospital and health system finance leaders optimize their organizations' revenue cycle? One of our hospital pharmacy optimization experts suggests focusing on the following areas:
1. Minimize billing mistakes
Reducing mistakes that cause claims to be denied or payments to be delayed should be a top priority for every hospital's revenue cycle team, according to Yen Nguyen, PharmD, vice president of products and services at McKesson RxO®.
Regular and consistent training for revenue cycle staff is an important part of decreasing billing errors. If even one team member fails to perform his or her duties correctly, it could mean significant revenue losses for your organization.
Nguyen also recommends that your hospital implement a revenue cycle technology platform that enables it to track claims through the entire life cycle. With claim lifecycle visibility, your hospital’s finance and revenue cycle leaders can see when a claim is submitted for payment, when the payer accepts it and whether it was denied or paid. This allows them to easily troubleshoot issues throughout the process to keep the claim moving and help ensure your hospital receives timely payment.
2. Improve coding accuracy
It is critical that your hospital is appropriately reimbursed for the services you provide and the supplies you use. If your hospital submits claims to insurers that are missing codes or include incorrect codes, it could lead to significant revenue losses for your organization.
Health insurance companies and government payers are not looking for ways to increase payments to hospitals and health systems. So it is up to provider organizations to identify under-reimbursed claims and improve coding accuracy to ensure revenue is not left on the table.
It may be difficult to notice under payments in a timely manner due to the volume of claims submitted. Drug reimbursement is one area your hospital could examine for under payments due to the complexity of drug purchasing and billing processes.
3. Centralize data
To determine if drugs are billed and reimbursed correctly, provider organizations need to aggregate data from clinical and financial systems to identify billing trends and outliers. Being able to pull and compare data from all sites of care has become more important as resources shift from acute-based care to outpatient settings.
Provider organizations of all sizes use numerous software systems to monitor and manage clinical care and financial metrics. These systems are not typically interoperable, which makes it impossible for providers to access the information they need to efficiently track revenue cycle performance. To overcome this challenge, your hospital or health system needs to create data repositories.
4. Analyze data to identify trends
It will become increasingly important for your hospital to have the ability to not only pull data from various disparate systems but to draw actionable insights from that data.
By analyzing data from medical billing statements and patient records, your hospital can identify trends and outliers sooner and make more informed decisions.
Many provider organizations are partnering with external partners who can help them understand the data and pinpoint problem areas.
Related: Learn about McKesson’s revenue recovery solutions and services for hospital and health system pharmacies