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Axios recently completed a poll to determine how Americans are experiencing the healthcare labor crisis. In the poll, over fifty percent of those responding indicated the labor shortage in the healthcare industry has directly impacted their life, and 25% reported having a procedure or treatment delayed in the last year. In a Becker’s Hospital Review article, 78% of respondents indicated they are concerned about the lack of hospital beds, while 80% were concerned about the shortage of staff.
While these statistics are directly related to nursing staff, the same is true for staffing levels across the board in healthcare systems. This includes the staff that manages and is part of the healthcare system’s revenue cycle management services. When these staff members are overwhelmed and overworked, there are errors, delays, and problems with reimbursement that directly impact both the healthcare systems and the patients.
Outsourcing your hospital’s revenue cycle management means bringing in an outside team to completely handle all of your administrative work where billing, coding, and other non-provider related tasks are concerned. This can be a strategic move that can save you time and money, while also freeing up your staff to focus on providing better care to patients. If you’re considering outsourcing your revenue cycle management, make sure to do your research first. There are a number of companies out there that specialize in this area, so it’s important to find the right fit for your hospital.
The Big Picture
An overall decline in the number of professionals on the job in healthcare systems includes medical coders, home healthcare aides, physicians’ assistants, nurses and doctors. All these professionals have a role in revenue cycle management, from entering patient data in the electronic medical records to actually processing the claim; these shortages all result in problems that ripple throughout the healthcare system.
Currently, as reported in an industry analysis by Mercer, there are approximately 6.5 million healthcare professionals who are likely to leave their current positions within the next five years. What is even more concerning about this number is that less than 2 million trained workers are available to fill those vacancies.
Revenue cycle management (RCM) is an important part of ensuring that a medical provider receives the funds they are owed. Often, it can be difficult and time-consuming to manage these processes on one’s own. Outsourcing RCM can be a valuable way to manage this process efficiently and ensure that billing is accurate and patients are properly compensated.
There are several steps involved in the revenue cycle: charge capture, claim submission, coding, and final payment to patients. Charge capture begins with rendering medical services into billable charges. Claim submission involves submitting claims of billable fees to insurance companies. Coding properly codes diagnoses and procedures in order to ensure accuracy of payments from insurance companies. Final payment to patients occurs when insurers pay out benefits for services rendered.
Outsourcing RCM can save medical providers time and money by allowing them to focus on providing higher-quality care instead of managing billing and finance paperwork. It also enables providers to concentrate on their core business instead of dealing with administrative tasks that can be avoided with outsourcing RCM solutions. This enhances patient care by providing more accurate fees for services rendered, which in turn raises the likelihood that patients will receive the benefits they are owed.
Adding technology and automation to revenue cycle management is one way to address the increasing requirements for patient data, EHRs (electronic medical records), and interoperability, or the ability for different healthcare ecosystems to access, share, and utilize healthcare data from the other systems.
Technology implementation or managing the staff levels can be difficult for healthcare systems. Partnering with a RCM (revenue cycle management) company with the ability to also offer HIM (health information management) services can solve the problem.
The outsourced RMC/HIM service provider should be specialized in working with healthcare systems. These companies employ highly trained individuals that provide the specific services required by the healthcare system. In addition, they are trained and knowledgeable about the latest in compliance issues at both the state and federal levels, which ensures fewer denials of claims or delays in reimbursement.
Ability to Scale
One of the challenges with in-house medical coding is the labor shortage in healthcare systems. By outsourcing this work to an experienced medical coding company, there is no limit on scalability as medical coders can be added to the team as needed to process the workload. Scalability will continue to be a critical consideration. Unfortunately, inaccurate and incomplete records were a significant issue and bottlenecked the revenue cycle for most healthcare systems during the pandemic and continues to persist. These issues continue to be a concern for healthcare systems throughout the country, with increased staffing shortages just the tip of the iceberg.
It is crucial to verify the HIM/RCM uses coders certified by the American Academy of Professional Coders (AAPC) and the American Health Information Management Association (AHIMA). This provides not only qualified professional medical coders but also ensures regulatory standards are maintained and all payer requirements are also accounted for in the system.
Look for an healthcare outsourcing company experienced in HIM/RCM with a focus on accuracy and productivity. This includes not only regular training for medical coders on staff, but also specific quality control measures to develop productivity and accuracy KPI or benchmarks that increase revenue and reimbursements while decreasing errors and subsequent claim denials.
Choosing to outsource HIM and RCM eliminates the need for the healthcare system to invest in the technology, software, staffing, and training required to do this in-house. It also maximizes the use of software systems that are designed and tested throughout the healthcare industry, ensuring a system that is turnkey ready.
These medical coding companies and revenue cycle management companies, such as GeBBS Healthcare Solutions,use both artificial intelligence, healthcare data analytics, and automation combined with highly trained human resources. This combination is constantly improving, utilizing big data to make more informed predictions and decisions that can help guide healthcare systems to more effectively navigate staffing issues and changing requirements for a positive patient experience.