How to Create a Patient-Centric Revenue Cycle


Knowing that it can be advantageous to a patient-centered practice and creating one are two different things. It sounds, technically, like an excellent idea. But there may be disagreement between your leadership and employees about where to start, what to change, and how to go about the process. It can be overwhelming and even detrimental to try and execute an all at once big overhaul of your practice. You will probably have the mechanisms for making smaller improvements that in smaller steps will lead you to a more patient-centered approach. This choice will encourage better preparation for staff and you can evaluate with more clarity the benefits of individual changes. There are also several software development companies that concentrate on developing and creating features according to the patient-centered revenue cycle of billing software.

Transparency is needed in a patient-centric revenue cycle, and transparency means that the back-end processes need to be as clean and effective as possible.

Historically, the patient-facing activities of suppliers have concentrated mainly on clinical experiences, whereas revenue cycle experiences between supplier and payer have been viewed as a business-to-business operation. However, the patient has now emerged as a key player in the revenue cycle equation, requiring suppliers to reinvent and redesign key revenue cycle processes to become more consumer-focused.

What is a Patient-Centric Revenue Cycle?

A patient-centered revenue cycle considers the customer in the billing process as a partner and responds with direct communication and clarity about pricing and payment choices to the consumer mindset.

The patient-centered revenue cycle of today requires the right systems to drive efficiency, but the use of systems focused solely on their robustness does not guarantee success. Only with a careful combination of people, processes and technology is optimum financial performance achieved.

Read Also: Why is Patient-centered care important in Healthcare?

The efficiency of the healthcare revenue cycle is especially difficult because of the dynamic nature of the services to be billed, the vast number of workers contributing to the process, the variety of processes and tools used to process billing, the changing relationships with patients and due to their increasing payment liabilities due to increased responsibility for treatment costs.

Healthcare IT solutions in India require appropriate infrastructure, adequate internal work processes, experienced individuals and appropriate metrics to optimize revenue cycle efforts. Organizations would fail to function successfully without these foundations. Focusing inwardly on best practices in the revenue cycle is critical for preserving organizational excellence without losing sight of the effect on revenue cycle results of the positive patient experience.

Healthcare companies will position themselves to be more competitive and gain market share in the coming decade by developing a patient-centric revenue cycle.

Steps to Building a Patient-Centric Revenue Cycle

We primarily have two measures to create a patient-centered revenue cycle. First one is to mitigate denials at every opportunity and another one is to use a financial responsibility document as a foundation.

#Step 1: Clear communication

The financial document should preferably be available in many languages, signed before the first contact to accept comprehension, and deposited in the patient record.

Financial document components should include:

  • An outline of financial obligations

Easy-to-understand communication is a key component in the patient-centric revenue cycle. Many businesses produce a document detailing the contractual commitments of patients for payer-approved claims such as copay, coinsurance, and deductibles. Information on standard insurance protocols for licences and certifications is also sometimes included in records, so patients recognise their position in providing treatment. The consequences of rejected claims (the patient may be liable for the full amount billed) and future next steps (such as collections) for unpaid bills must not be ignored.

  • Cost estimation policy and payment options

Estimates of costs are critical for patients. If figures are available and how to request one, the financial document is the place to let them know. Also, data on payment choices, such as payment plans and credit-card-on-file, will assist patients to prepare for large bills. The financial document should include next steps and contact details to learn more if your company has resources to help patients access financial assistance or Medicaid coverage.

Read Also: Patient Engagement Strategies and Benefits in Healthcare
  • Accountability confirmation

Patients also do not completely appreciate how detailed demographic and insurance information impacts claim adjudication. To avoid denied claims, the financial arrangement is the perfect way to explain that patients have a duty to ensure that reliable paperwork is on file with the office. The obligation to respond to the insurance provider regarding the conditions that necessitated the appointment, such as an injury, is another step in the claims process that patients often miss. If they are awaiting information from the patient, payers will refuse to pay claims.

#Step 2: Avoid denials with next-generation RCM technology

With patients more sensitive than ever before for the billing process, denials, to keep patients, must be avoided. A survey showed that the most difficulty with denials was identified by organizations using three or more RCM systems alongside their EHR. Via ongoing auditing on all claims platforms, next-generation healthcare business assurance technologies will help reduce denials.

Another instrument that helps providers to anticipate potential issues with authorizations, payments and lawsuit adjudications is predictive analytics, a core component of business assurance. Real-time warnings signal potentially denial-inducing situations and allow notifications of information and corrective steps to be taken before a claim is generated, even when the patient is still in the hospital, thereby enhancing the experience of the patient by consequently preventing surprise billings.


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