Healthcare Revenue Cycle Management: Challenges & How We Curtail Them?

RCM Challenges and how we can handle them

Revenue Cycle Management is a large-scale payment, collection, and sales processing technique popular with healthcare providers. It is a set of all administrative and clinical functions carried out to capture, manage, and collect patient service revenue throughout a patient’s journey with the service provider.

The ultimate goal is increased and more reliable earnings while delivering quality patient healthcare services.

Thus, to continue delivering optimal patient care and succeed as a business entity, it becomes imperative for service providers to have an efficient, healthy, and financially strong Revenue Cycle to thrive in the practice. 

Healthcare revenue cycle management is a complex process, especially, in today’s time where the demand for medical care is at its peak. Revenue Cycle Management takes place in an environment where there are many different obstacles and challenges at different proceeding levels that need to be overcome to ensure success.

Healthcare revenue cycle management has always been a challenging field. It’s not easy to handle the complexities of the industry without the right knowledge. But there are many things that can be done to improve it.

Revenue Cycle Management Major Challenges and How We Curb Them Along

#Lack of Transparency


One of the major challenges is the lack of transparency between payers and providers. This lack of transparency leads to confusion about what charges are considered out-of-network, the amount patients should expect to pay, what charges are covered in the insurance, and how they should track their payments. 

This leaves patients in the dark about the costs related to their healthcare experience. 

How do we help to maintain price transparency?

Being a leader in leveraging Intelligent Automation in Healthcare, we make use of intelligent software tools to set machine-readable files that consists of in-network provider negotiated rates.

[Prefer Reading: “Automate RCM Processes to Reduce Expenses & Debt Collection”]

#Tracking Claims and Managing Denials

Monitoring claims is one of the significant aspects that cannot be left only to be processed by manual efforts. Errors and delays while handling claims may not be easily identified or resolved which results in rework and loss of revenue to the service provider.

Moreover, when claims get denied it becomes a tedious task to resubmit or refile them and majorly affects a practice’s bottom line. Each denial is accompanied by the risk of not getting paid for the delivered services and incurs overheads along with time wastage.

Leaving even a single error in claims and denials management impacts adversely on a  practice’s revenue generation streams and diminishes their chances of being paid what they deserve.

How do we Manage Claims and Denials?

Insurance processes are too variable and aren’t as easy as they may look. The claims data exists in numerous formats and is shared in different ways. We enable automation to digitize the workflow, making it easier for the staff to forge claims and deny data that is error-free.

Automated claim processing followed by digital workforce goes as:

Self-service claims submission –>Intelligent document processing → AI-ML based adjudication –>Computer vision damage evaluation –>ML-bsed fraud detection

The digital workflow further prevents claim denials, resulting in accurate claims, reduce denials and significantly higher payer reimbursements.

[Prefer Reading: “Top Tips to Design Digital Experiences for High Patient Engagement & Revenue Gains”]

#Payment Collection

With the rise in consumerism, patients are themselves responsible for more of their healthcare costs. Practices must ensure ways that to collect patient payments without resorting to ‘high-pressure sales tactics’ which may compel patients to switch providers and seek care elsewhere. 

How do we resolve this?

The team of NetSet digital is periodically educated to get deep insights over the payment workflows of your practice and get acquainted with the new regulations been implemented within the medical organization or the healthcare industry.

Establishing diverse payment plans, verifying eligibility and benefit checks (through automation), enabling pre-authorization are a few steps taken by our professional workers to avoid delays in reimbursements and accelerate payment collections.

[Prefer Reading: “Top Tips to Improve Medical Billing Process & Revenue Generation”]

#Changing Regulations and Reimbursement Models

The healthcare rules and regulations are dynamic in nature which further tend to complex the reimbursement models as per the occurred changes. With new rules and policies introduced every year, it becomes challenging for the healthcare organizations to adjust to the alterations and certainly impacts the administrative functions involved in the billing and revenue cycle of practice management.

How do we make a contribution?

We at NetSet Digital possess a physical and well as a digital workforce that stays up-to-date with the changing healthcare requirements where our experts understand, regulate, and performs their tasks with adherence to the policies and in compliance with the latest regulations.

#Rendering Patient Satisfaction

Ensuring that all patients are satisfied with their experience is a key component to the success of a hospital or clinic. It not only speaks to the care they provide but also how they are regarded within the community.

“Low Patient Satisfaction, Poor Financial Outcomes.”

But it doesn’t seem easy for every provider to render a high level of patient satisfaction due to improper quality of health service delivered which further involves a myriad of aspects. 

How do we ensure patient contentment?

The best strategy for managing patient satisfaction is to employ an approach that focuses on both active and passive strategies. Active measures involve listening and responding to complaints directly, while passive efforts involve looking for trends and patterns

[Prefer Reading: “Care-on-Demand: A Visible Approach to Digitize Patient Intake Process [NetSet Digital]”]

Seeking to Eliminate Healthcare RCM Challenges and Streamline Data Collection, and Revenue Generation?

Outsource your Revenue Cycle Management to a reliable partner like NetSet Digital that conducts a systematic analysis of every component of the Revenue Cycle Management that seeks to highlight relationships that can be improved or expanded to increase the revenue base.

We help healthcare providers to encourage tactical attempts within their practice to increase the degrees of patient satisfaction, reduce the risk of medical malpractice, orchestrate claims and denials, increase the likelihood of business recurrence: all via the support of Intelligent Automation and Smart Strategies.

Let us make it easy for patients and more reliable for you (a service provider).

[Prefer Reading: Wipe Out the Dilemma: In-House or Outsourced Medical Billing Operations?]


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