There’s no doubt that a thriving healthcare revenue cycle is useful for reducing and preventing errors during the medical claim process for patients. Various factors are there that contribute to these errors. However, if healthcare organizations are having an agile revenue cycle management strategy, then this can eliminate these errors.
Another factor that is lucrative and helps in improving health management strategies is value-based care. Value-based care is all about advancing the aim of healthcare facilities for providing better care for individuals and reducing healthcare costs. Over the years, there can be seen a shift from fee-for-service to value-based care. What does it mean? Well, in simple words, it means that healthcare organizations must adapt to be and remain successful.
Revenue Cycle Management and Shift to Value-Based Care
Why there’s a need for value-based care along with a revenue cycle? Well, healthcare organizations can evolve their revenue cycle management strategy and make it better in many ways. These ways include connecting clinical and financial data and controlling the collection costs. With this, healthcare facilities will not only protect their revenue but will also ultimately deliver the best financial outcome to the patients.
- The shift to value-based care delivery and reimbursement has completely changed the traditional model of healthcare reimbursement. Today, healthcare providers’ payments are based on the value of care they deliver and not only on the number of visits and tests that they make.
- With Revenue cycle management (RCM), the healthcare providers ensure fair and full reimbursement for the care that they offer to patients. Some people might confuse a fee-for-service system with value-based care, but both are different. The fee-for-service system is a direct process in which all the medical encounters are documented in the electronic health record, claims are submitted, and followed through to payment. However, if a hospital is following a Value-Based Healthcare model reimbursement then it will be dependent on quality and cost performance.
While entering the new age of value-based payments, the entire health management will need more and better solutions. Along with this, there will be a requirement for care team integration. Thus, most healthcare organizations and financial leaders are preferring healthcare revenue cycle management services. With the help of RCM, healthcare facilities can easily free up labor resources and then emphasize the consumer-facing side of the revenue cycle.
RCM In Delivering Value-Based Care
When a healthcare organization starts implementing revenue cycle management, there won’t be any issues of errors. Also, they don’t need ample time or money in rectifying the errors and then appeal for the claims. Because of this, the providers will be able to put more time and money into the quality of care that they provide.
In addition to this, revenue cycle management can help healthcare providers to make the transition to value-based reimbursement practices instead of not-so-beneficial traditional fee-for-service practices. So, there’s a need for the implementation of a clinically driven revenue cycle that can work effectively for improving RCM performance and preparing for value-based care. Many providers look for healthcare BPO services that can help them implement RCM and offer value-based care to patients.
Capabilities Of Revenue Management Cycle for Value-Based Care
Though RCM plays a key role in delivering value-based care, it still requires some new capabilities to adapt this model. Here are some of the main capabilities that one needs to focus on:
- Real-time information flow and visibility: RCM needs to have the feature of real-time information. With this, the healthcare providers can easily and quickly identify abnormalities affecting the revenue and clinical outcomes during the episode of care.
- Secondly, the new revenue cycle management solutions need to be accurate in estimating related clinical, quality, and financial data. In addition to this, RCM must be to document both risk and care at the activity level.
- Another capability that the new RCM solutions need to have is the precise measurement and improvement in the performance of some new set of metrics. The metrics for the value-based reimbursement are not only limited to volume but also include the health system’s cost and quality for making better decisions. Some of the crucial new sets of metrics to focus on are quality, throughput, patient satisfaction, mortality rates, and cost per episode of care.
- For value-based care, the new RCM strategy needs to be patient-centric. One thing to consider is that the revenue cycle team and processes can either improve or damage the patient’s experience and perceptions. As these are the common determinants of reimbursement in the value-based model, healthcare providers need to focus on them.
Revenue Cycle Management assists and will keep on assisting the healthcare industry in transitioning from fee-for-service to value-based care and reimbursement. The analytics of implementation of RCM both the healthcare providers and payers help to monitor the claims data and identify potential abnormalities.
The transition to value-based care is useful for healthcare providers but it also brings many challenges for revenue cycle management. However, those who adapt to RCM with the capabilities can use the transition as an opportunity to succeed.