Everything You Should Know About Healthcare Revenue Cycle Management Analytics
Table of contents
- 5 Challenges In Healthcare Revenue Cycles
- What is Healthcare Revenue Cycle Analytics?
- How Does RCM Analytics Help Overcome Challenges In Healthcare Revenue Cycles?
- Benefits of RCM Analytics in Healthcare
- How Do You Select Revenue Cycle Analytics Software?
- The Role of Healthcare Revenue Cycle Management Analytics in the Future of the Industry
- Frequently Asked Question
The healthcare industry is constantly shifting, thus indeed making it important to have a solid revenue cycle in place, as it determines the profitability of the service providers. However, increasing expenses, shortages of manpower, and growing complications in the payment structure take a toll on this focus. Healthcare Revenue Cycle Management (RCM) analytics helps practitioners understand important trends for cost control processes, financial performance, and patient care enhancement.
In this article, we will discuss Healthcare Revenue Cycle Management Analytics, identify its challenges and opportunities, and explore how predictive analytics can shape the industry’s future.
5 Challenges In Healthcare Revenue Cycles
Many issues arise in the healthcare revenue cycle that affects both the cash flow position and overall customer satisfaction. Some of the main challenges are listed below:
- Rising Denial Rates
- Staffing Shortages
- Soaring Costs
- Limited Price Transparency
- Shift to Value-Based Care
Let’s take a look at them in detail:
Rising Denial Rates
Denial management continues to be a major challenge. 50% of providers have seen a spike in denial rates last year according to an AKASA survey which shows that denial management is an important area that needs to be focused on to avert denials.
Staffing Shortages
There is a dramatic shortage of staffing in the healthcare sector. Almost 60% of hospitals and health systems report more than 100 vacant positions. This worsens operational inefficiencies since many of the processes in the revenue cycle management function are prone to delays and mistakes.
Soaring Costs
In the United States alone, healthcare prices are expected to increase by 7% over the next year. The increasing number of patients with high deductibles often delays or prevents them from receiving the needed care and even reduces revenue.
Limited Price Transparency
As an AKASA poll reported, 35% of Americans do not seek help because they are not certain how much they will have to pay, and this results in poor outcomes and high costs of provision of healthcare.
Shift to Value-Based Care
More and more patients are being treated under the value-based care frameworks with a projected increase of 15% every year as per McKinsey. After this transformation, it follows that revenue cycles also have to learn how to accommodate the new ways of repaying.
What is Healthcare Revenue Cycle Analytics?
Healthcare revenue cycle analytics refers to the use of analytical frameworks that provide the best prescriptions for improvement of every stage in the revenue cycle from the moment a patient is registered until the last bill is settled. It includes monitoring KPIs and performance trend analysis and employs predictive analytics in revenue cycle management to proactively diagnose problems and provide solutions.
Implementing revenue cycle analytics in healthcare practices allows providers to turn unprocessed information into effective operational insights, increasing service efficiency and reducing costs and messages to patients.
How Does RCM Analytics Help Overcome Challenges In Healthcare Revenue Cycles?
RCM analytics empowers healthcare organizations to address the challenges outlined above through:
- Prevention and Management of Denials
- Planning Their Workforce Effectively
- Proper Cost Control
- Increased Transparency
- Transitioning to Value-Based Care Models
Prevention and Management of Denials
RCM analytics allows providers to identify trends for claim denials, allowing providers to address the root causes of denial proactively. By studying the root causes of the denials, healthcare organizations can make a number of changes that will significantly lower the rate of denials.
Planning Their Workforce Effectively
Some RCM analytics allow providers to manage, and reorganize workflows, and adapt work and staffing patterns and efforts, helping to lessen the effects of lack of staff.
Proper Cost Control
Healthcare revenue cycle analysis enables providers to grasp the revenue and cost generators and optimize financial efficiency. This includes analyzing patients’ payment patterns and introducing charity options for financial assistance.
Increased Transparency
Analytics make it constant by assisting with price transparency so patients are able to know costs ahead of deciding on care.
Transitioning to Value-Based Care Models
Revenue cycle analytics makes it possible for organizations to plan their transition to value-based care models by predicting revenue effects and aligning their operations to that goal.
Benefits of RCM Analytics in Healthcare
The advantages of healthcare revenue cycle analytics are wired to the operations, finances, and patient care scopes:
- Enhanced Efficiency
- Improved Financial Outcomes
- Better Patient Experience
- Data-Driven Decisions
Enhanced Efficiency
RCM analytics collects data relevant to repetitive processes and pinpoints weaknesses in the systems in place so that quicker and better processes can be implemented.
Improved Financial Outcomes
Analytics, by lowering denials and enhancing payment collection processes, increases revenue and profit.
Better Patient Experience
Due to the clarity of the billing process and payment assistance options offered, patients’ trust in their caregivers is developed which in turn improves their satisfaction and loyalty.
Data-Driven Decisions
The revenue cycle management tools provide insights into the decision-making process where institutions do not have to guess when making policy changes.
How Do You Select Revenue Cycle Analytics Software?
The selection of the revenue cycle analytics software should be taken carefully as this is an important aspect of the company’s success. Some of the considerations are:
Comprehensive Features
When seeking such software, ensure there is denial management, predictive modeling, patient payment insights, payer performance analysis, automated workflows and cost analysis.
Integration
The software must be compatible with other software, such as EHRs and Practice Management applications.
Ease of Use
The software must be easy for the employees to operate without having to go through extensive training during the implementation process.
Scalability
One should be able to use or purchase a solution that does not restrict their growth and future requirements.
Vendor Support
Choose a provider who offers extensive customer support and periodic software improvements to stay informed about the latest developments in the healthcare sector.
Also Read: What Is Revenue Cycle Management And What Are Its Benefits?
The Role of Healthcare Revenue Cycle Management Analytics in the Future of the Industry
As more industry players adopt value-based care, analytics will help balance the cost of care with the cost of the services rendered to the patients. In addition, the future integration of RCM analytics to telehealth and remote monitoring will only help broaden the scope of RCM analytics.
Healthcare revenue cycle analysis is a matter of survival for providers who need to maneuver the windmills of the modern-day healthcare system. Striking the right balance between addressing problems, enhancing effectiveness, and availing predictive insights, RCM analytics changes the revenue cycles into a sustainability tool.
As competition in the sector increases, so will the advantages of being an early adopter of robust revenue cycle analytics software combined with a data-driven culture.
Frequently Asked Question
Q1. What are the key performance indicators for the healthcare revenue cycle?
Indicators of performance or KPIs for the healthcare revenue cycle include claims denial rate, A/R days, payment collection rates, and collections cost-to-revenue ratios.
Q2. What is revenue cycle analytics software?
A revenue cycle analytics software is a specific application that integrates healthcare revenue cycle operational and financial data to assist in identifying deficiencies, forecasting, and improvement strategies.
Q3. What is the role of predictive analytics in revenue cycle management?
Predictive analytics in revenue cycle management assists in trend predictions, forecasting specific events including claim denials, and adjusting processes to achieve better financial performance and the patient experience.
