What Is Next Generation Revenue Cycle Management?

In the healthcare world, revenue cycle management covers all of the administrative processes that deal with revenue to you and your practice, and should include your claims processing, collections and payments, and all other relevant tasks for revenue generation.  In other words, it should help you monitor your claims and payments throughout the life cycle of every interaction with your patients.  It begins when a patient first schedules an appointment and ends after all payments for that encounter have been collected and delivered to your practice.

The next generation of revenue cycle management looks to improve service to patients and to reform healthcare payment and delivery systems by taking advantage of the new regulations driven by the PPACA.  Shifting the focus from the current fee-for-service system to a value-based system can enable incentives for both preventive care and extended treatment plans for chronic care.

With the legacy fee-for-service structure, revenue is primarily driven by volume.  Patients are billed per visit, per item, or per service which may end up looking like shopping list healthcare.  The next generation revenue cycle approach is a way of addressing value-based care which actually structures health treatment programs for your patients.  For example, you can take advantage of bundled payments, where you receive a fixed amount for a bundle of services or an overall care program that the patient is expected to need during a defined time period for the entire episode of care.  This creates an incentive to provide preventive care and better overall care coordination.

As you look to incorporate the next generation methods, you should assess what your practice needs as a whole.  Evaluate your current revenue cycle processes to determine if they are thorough enough to take on the new requirements as is, or whether you need to look for help in implementing better processes.  At the same time, you should be open to service providers who can take you to a new level of revenue cycle management, and establish a clear vision on how new processes can best serve your patients.  While many new technology solutions are appearing to fill the need in this space, you should consider your options carefully and not make hasty decisions until you understand what you need and what solutions are available.  It is unlikely that simply implementing a new technology will meet all your needs.

When you begin to assess how to implement a value-based revenue system, and are looking for service providers to get you there, keep the following basics on your list of needs:

• Help on improving overall monthly cash flow by addressing the delays caused by dealing with co-pays, deductibles, insurance claims and appeals, and collections.
• Reimbursement maximization by reducing errors in general billing processes and by ensuring that codes are being properly applied.
• Compliance expertise for both old and new regulations that will help BOTH monthly cash flow and reimbursement maximization.
• Experience and expertise around revenue management to enhance overall efficiency.
• Knowledge and experience with the new payment paradigms available in the marketplace today. 

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