The burgeoning era of value-based care demands a new strategy for healthcare revenue cycle management, leaving many organizations bewildered, but there is help at hand from dedicated solutions that can marry the patient-facing front-end with the business back-end.
Financial accountability in the value-based care model falls on the healthcare organization, thus providers need to update their healthcare revenue cycle management in order to incorporate the data analytics, population health management and billing techniques that are required.
Sounding like a massive undertaking? Many healthcare providers would be inclined to agree as they try and manage the two faces of billing and coding effectively.
The front-end of the healthcare revenue cycle covers the patient-facing side of things, with the generation of income coming from patients that seek, and receive, care from the hospital or other provider. As such, the front-end must ensure that patients are efficiently scheduled for appointments with the right person, at the appropriate time, and with minimal no-show rates. Furthermore, patient registration and eligibility checks need to be undertaken to try and avoid denial of claims at a later stage.
It follows that data collection is key here, including a patient’s demographics, insurance details (e.g. will they be covered for the services they need, and for how many repeated times?) and other ‘routine’ enquiries.
Once data is documented, and coding is completed for patients, the revenue cycle progresses to the business back-end, where management and reimbursement take the lead.
Translation of a treatment, service and/or physician’s time into a billable value is handled by the back-end, but the journey from coding to billing requires a lot of leg work, as well as accurate and complete clinical data from the front-end. Without this, inaccurate charges or missed payments can be expected.
Indeed, unpaid claims are the bane of healthcare revenue cycle managers, but many organizations may not be giving due focus to resolving such denials, instead spending more time and effort on new claims. A shift in strategy, however, might mean that as many as 90% of denials could be prevented.
Once claims are confirmed (whether at first application, or after initial denial), the management marathon continues, with patients often needing to be chased on any outstanding balances due. The reality is that many bills remain unpaid, or are very late when the balance finally changes hands.
The big picture
Some would say a criticism of the overall coding and billing cycle is that front-end and back-end staff are not aware of the entire process as a whole. As such, better communication and workflow from both parties has the potential to improve the overall revenue cycle.
But how can this be done? Internal reorganization is one way, of course, but the expertise and/or time constraints may be a significant bottleneck. Another more elegant solution might be the use of cutting-edge technology, usually outsourced, which can step in to better manage the whole coding and billing process.
When used appropriately, such solutions can free staff from costly, inefficient processes, and relieve pressure in areas such as claims denials, data collection and analyzing/predicting the trends in healthcare provision and reimbursement.
QueueLogix – a suite of technology solutions from the ScribeAmerica healthcare solution family – promises to ‘supercharge’ the billing and coding processes at hospitals, healthcare systems, private practices and emergency departments, making their revenue cycles faster, stronger and better.
With coding offered in real time, and billing performed in minutes rather than hours, QueueLogix hopes to give back the precious time that physicians and other front- and back-end staff need to action an effective and accurate value-based care revenue stream.
Underpinning QueueLogix is a connection between back-end and front-end. This is achieved with back-office business operations – e.g. email alerts, real-time analytics and custom reporting – harnessing the skills of coding experts and medical scribes in real time, facilitating faster decision-making, and greater transparency. QueueLogix then instantly identifies correct codes to increase accuracy, reduce the billing cycle, and improve opportunities.
QueueLogix is made up of several modules, the first being LiveData, which joins clinical and financial information together, making visualization of the data as a whole, and detection of any errors, quicker and easier. Live Task offers a platform from which medical coding personnel, CDI teams, compliance and quality review professionals and beyond can collaborate. With a custom design, LiveTask’s cloud-based, process-driven work queues allow monitoring and review of all stages of the revenue cycle.
Live Sentry is an artificial intelligence module that utilizes pattern analysis to isolate and capture patient encounters that may require further inspection or action before billing can continue. Organizations can harness the module to create simple or complex rules that flag up certain criteria to make sure lost reimbursements or denials are avoided where possible.
Finally, LiveCode exemplifies the unique linking together of ScribeAmerica’s highly-trained scribe personnel at the point of care with advanced, cloud-based technology. This connection helps overcome the significant challenges of joining together clinical and back-office teams.
Marriage made in heaven?
The healthcare revenue cycle is undoubtedly complex, and with so many links in the chain it is perhaps understandable that there are weaknesses. With missed payments and unchallenged denials being a key concern as value-based care enters the fore, initiatives such as those offered by QueueLogix could help ensure a smooth flow of revenue is sustained.