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How to Close Your Revenue Gap with Effective RCM Strategies in a Value-based World 

According to EY research, value-based care innovation and investment are booming, with more than $25 billion in related merger and acquisition (M&A) activity in 2021. Payers and providers are rethinking how to acquire the capabilities required to keep up as market forces push the US healthcare system to reward better health outcomes and value over volume. 

The transition to value-based care is being sped up by pressures brought on by consumer expectations, governmental policy and regulations, and the pandemic. Employers are also assisting in the transition by collaborating with value-focused businesses through sponsored plans or joining networks pioneering new ways to provide better employee care at lower costs. 

This guide will discuss tips to close your revenue gap in a value-based world using effective revenue cycle management (RCM) strategies for higher reimbursements. Besides, it will explain what value-based care means for your RCM and how you can close the revenue gap in your value-based revenue cycle management model. 

What Value-based Care Mean for Your Revenue Cycle Management? 

Your clinical and RCM workflows need to be better integrated due to the transition to value-based reimbursements, patient-centered incentives, and quality-of-care programs. Patients must receive consistent and accurate communications throughout their healthcare journey, positioning them for the best possible health outcome and payment options.  

Moreover, your patient records can be kept up to date in your electronic health records (EHR) software, and the subsequent administrative task will be triggered at the appropriate time when the care and financial functions collaborate.  

The following items may be absent from your revenue cycle management (RCM) process: 

  • Your RCM solution may lack procedures for patients that are simple and convenient. 
  • From registration to billing, accurate patient identification, and the ability to work with payers to create custom workflows. 
  • Streamlined processes to save time and resources on unnecessary tasks. 
  • Automated methods to aid in influential collections and identify the denials’ underlying causes. 
  • Your current revenue cycle management process may be failing to perform real-time reporting to assist with performance improvement over time. 

How To Close the Gaps in A Value-based RCM Model 

Providers can take advantage of these chances to prevent revenue loss amid a value-based care reimbursement model by implementing revenue cycle management analytics and population health management strategies.  

Providers should implement revenue cycle management strategies and claims data analysis more effectively when preparing to shift to a value-based care payment contract, whether through an accountable care organization or a bundled payment. 

Utilize Consumer Information to Aid Patients in Making Wise Decisions 

Patients’ lack of knowledge regarding the price of their treatment is a significant factor in rejecting claims. Others are still determining if they have the proper insurance. By giving them accurate estimates and working with them to verify coverage, you can assist your patients in weighing their financial options. This will ultimately lead to a better revenue cycle management process and a positive patient experience. 

Consumer data can support this process by providing details about your patient’s social identity, medical history, insurance eligibility, coverage status, and propensity to pay. You’ll enhance patient payment experiences and lower revenue leakage with an easy-to-use billing process. 

To Anticipate Gaps in your Revenue Cycle Management, Use Analytics 

High-performing health systems frequently use advanced data analytics to anticipate potential bottlenecks, errors, and denials to quickly address them and maintain patient and executive satisfaction.   

For instance, you can segment your patients based on their financial responsibility and ability to pay by using analytics to understand them better. It allows you to concentrate your collection efforts more successfully and gives you the knowledge you need to guide patients through the payment process with individualized reminders and pertinent messaging.  

Additionally, analytics can significantly reduce avoidable denials from unreliable or inaccurate patient data. You will be able to identify trends in contradictions so that you can put procedures and checks in place to prevent them in the future. Doing so will also result in a successful RCM process. 

Set Up the Appropriate Tools to Fill in the Gaps 

Making sure your patients know their financial obligations is the first step in reducing the growing gap between claims and collections. Your patients may easily access their information through a self-service patient portal at a time and location that works for them.  

They can make appointments, sign up for payment plans, and submit a charitable application. They will see up to date, transparent, and precise price estimates and information about their eligibility and coverage.  

Patients are more likely to feel satisfied and are less likely to shop around for care when the financial process is transparent and hassle-free, not to mention that they are better equipped to meet payment deadlines. 

Conclusion

By enhancing patient health outcomes in a value-based care setting, revenue cycle management analytics and big data analytics using EHR data may help to stabilize healthcare revenue and spending. As CMS continues to anticipate, quality metrics and patient-reported outcomes will become a staple of the healthcare revenue cycle. 

Ahsan Khan
Ahsan Khan
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