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Revenue Cycle Management Healthcare Challenges

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The rising healthcare cost has shed the light on the importance of revenue cycle management in healthcare, it has become a topic of interest in healthcare management and healthcare economics to a lot of healthcare management professionals.

As we talked earlier in our article “Healthcare Revenue Cycle Management (RCM) Important Approach That Hospitals Should Follow” Healthcare Revenue cycle management (RCM), mentioned the benefits of this system and this could reduce waste of your hospital revenue.

Revenue cycle management challenges have become a main obstacle in applying an efficient RCM process specially for healthcare providers in the Middle East & Africa region.

In this article, we will talk about revenue cycle management healthcare challenges to elaborate the reasons behind running this process efficiently

The Non-medical work includes taking care of all the documentation, eligibility verification, demographic entry, billing & coding and filing of the medical claims.

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If a single step is overlooked, the claim will be rejected. Thus, a disorganized revenue cycle management can lead to an accumulation of uncollectible money with no proper process to streamline it.

So, now let’s go through top revenue cycle management (RCM) challenges that face most of the healthcare providers.

Employees Training

Of course, training is one of the most important continuous development processes but in our case with a new term like (RCM), training becomes a key development tool for your hospital.

So, if the healthcare workers are not trained properly, it will be a whole mess. Starting with patient registration, medical coding, billing to capturing the data, everyone needs to be trained properly so that there is no shortage anywhere in the process.

These training sessions will directly impact your ROI as it will lead to reduced coding and billing errors as well as lesser turnover rates.

Documents cycle flow

if there is no information exchange between different departments, it can lead to a loss in time and might result in increased healthcare costs in hospital.

documents cycle is the ability of systems to communicate and exchange information freely.

Healthcare (RCM) workers should have access to the patient’s data, and they should be able to integrate it with any other system easily.

sure, if you have universal standards in healthcare technology, documentation flow problems will be at minimum level.

Coding and Billing

Medical coding & billing are vital for a practice, which, if done correctly and timely can establish a smooth revenue cycle.

It requires extreme care as it is directly related to claim submission. However, the actual scenario is different.

for sure there will be a percentage of the claims paid are incorrect and the healthcare organizations must bear a loss of their total entitled money.

Therefore, to avoid as many claim denials as you can, your hospital must employ well-credited medical coders and billers who are experts in denial resolution, claim follow-up, bill adjustments, claim appeal submission, etc.

You can also collaborate with an expert vendor who has expertise in the ICD-10 & ICD 11 coding systems.

This way you can safeguard a positive cash flow in your organization, eventually boosting your revenue cycle.

Healthcare Information system

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When there is no health information exchange among different departments, it can lead to a loss in time and might result in increased healthcare costs borne by the hospital.

Healthcare Information systems have the ability of systems to communicate and exchange information easily.

Healthcare workers should have access to the patient’s data, and they should be able to integrate it with any other systems easily.

so, it would be great if you can adopt universal standards in healthcare technology and deploy a good hospital information management solution.

Data Analytics

Data analytics will play a major role to change the face of the healthcare industry. It can optimize a clinician’s time, cash flow, and health information.

As a provider, you can save a vast amount of your manual effort required in doing the administrative work by adopting the latest statistical, mathematical, and analytical tools to come up with accurate conclusions.

With healthcare data analytics, you can Bring visibility with some powerful solutions.

Maintaining Low Average, A/R Days

One of the key ways to improve revenue cycle management in healthcare is optimizing the claim submission process. And lower the days in accounts receivable (A/R), the faster will be the payment. It can maximize the revenue that you are entitled to.

Make a strategy on how to maintain a faster A/R cycle. Moreover, create benchmarks on the age of the claims. Most of the days on A/R should remain lesser than 50, and if it shoots up to 90 or 120, you have to follow up on those unpaid claims.

You can also identify the patient account that can extend the stipulated time, and segregate those with the rest.

The Conclusion

Revenue cycle management healthcare challenges should be taken into consideration if we need cost-efficient management for healthcare facilities, it can affect the financial performance of any healthcare provider.

Dealing with these challenges would help a lot in the leverage of healthcare facility revenues.

Many factors might shape a challenge in RCM including trainings, workflow and digital transformation of the healthcare facilities.

All these challenges need to be handled altogether to achieve better results.

If you liked this article, please don’t forget to share your thoughts and best with HBC in the comments and let us know your opinion about revenue cycle management healthcare challenges in the Middle East and African countries. If you have valuable content to share on Healthcare Business Club you can publish your content for free and share your knowledge with all healthcare business professionals, send your articles to the HBC editorial team on [email protected] please don’t hesitate to contact us at any time.

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Ahmed Ezz Eldin
Ahmed M. Ezz EL-Din, MBA - is a Senior Cost accountant for healthcare services in Egyptian General Authority of Health Insurance, Former member of the Standing Committee for Pricing of Medical Services in universal health insurance (UHIO), experience in calculating healthcare services costs and preparing price lists for health care services, has established the cost system in many governmental and private hospitals also participated in preparing healthcare service price lists in the Egyptian Ministry of Health and Universal Health Insurance (UHIO)

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