Managing the revenue cycle has never been easy, but today’s healthcare landscape makes it especially difficult. While high quality patient care might have been enough to sustain a clinical practice in the past, most who work in the field recognize that is no longer the reality. Rates of claim denials are rising, catapulting provider organizations into a seemingly endless loop of rework and write-offs, resulting in significant revenue loss over time.
Part of the problem is increasingly complex payer rules, which can hinder the clinical documentation process and compromise clean claims. Denials don’t just affect an organization’s bottom line either—they disrupt clinical workflows, often forcing physicians to clarify or redo documentation.
To halt this cycle, IMO Health developed a solution that leverages rich clinical terminology and focuses on proactive intervention, triggering real-time alerts in the electronic health record (EHR) and delivering a 10X annualized return on investment (ROI)—just ask MetroHealth, a non-profit public health system that achieved remarkable results immediately after implementing this administrative coding solution.
Ready to learn more? Read our latest insight brief for the inside scoop on how to streamline RCM processes, reduce denials, and improve financial outcomes.
For a preview of the inside brief, keep scrolling:
The challenges of revenue cycle management
Exceptional patient care is not enough to sustain a profitable clinical practice today. Prompt and accurate payment for services is equally vital to safeguard and optimize financial performance. This process, known as RCM, spans the entire healthcare continuum, from registration and appointment scheduling to final collection of payment.
Accurate clinical terminology that aligns with standardized codes can enhance RCM by enabling a more seamless claims submission process. Precise documentation also plays a significant role in influencing risk adjustment factor (RAF) scores and landing on the correct Medicare severity diagnosis-related groups (MS-DRGs), directly impacting reimbursement. Healthcare providers who lack effective documentation and coding practices often face higher rates of claim denials, forcing them to choose between costly rework or write-offs.
While RCM may seem fairly straightforward, it’s complicated by a host of factors related to coding, billing, compliance, and more. Payer processes, such as prior authorization requirements, medical necessity denials, and administrative coding denials, can extend payment timelines, resulting in significant revenue cycle costs for most health systems.
However, the strain goes beyond finances. Administrative coding denials in particular – and the resulting rework – can severely disrupt physician workflows. Providers are often pulled away from patient care to address…
