Next-Generation Revenue Cycle

June 11, 2014
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revenue cycle healthcareWith the increasing adoption and implementation of the Patient Protection and Affordable Care Act and its various components, the financial reimbursement picture is drastically changing. We now have an increased emphasis on value-based reimbursement, risk sharing and bundled payments instead of just volume-based reimbursement.

revenue cycle healthcareWith the increasing adoption and implementation of the Patient Protection and Affordable Care Act and its various components, the financial reimbursement picture is drastically changing. We now have an increased emphasis on value-based reimbursement, risk sharing and bundled payments instead of just volume-based reimbursement. In addition, there is now an increase in the patient portion of reimbursement that needs to be taken into account.

Many healthcare leaders would agree that improvements to revenue cycle management systems can help healthcare providers tackle new and changing market realities. However, deciding which changes are best for the long-term can keep these same leaders up all night. One such change is the switch from legacy revenue cycle systems to next generation revenue cycle systems. But, as healthcare journalist Rodney Moore reports in a recent article, providers need to think before making the jump into new management technology.

Most healthcare providers have been struggling with wholesale challenges, such as a weak economy and reform and regulatory changes that have changed how they are able to do business. Additionally, providers have been forced to rethink financial strategies in order to integrate with emerging trends that include the shift towards consumer-directed health care, pay-for-performance programs, and the increase of patient payments.

Next-generation revenue cycle systems offer greater flexibility and are more consumer-directed than traditional revenue cycle management systems. The following are a couple of the more popular features of next-generation management systems:

  • Clinical and Financial Integration. Often, health care in older systems is provided without any understanding of payer responsibility or reimbursement. However, with an integrated clinical and financial system, providers can make care decisions with a better understanding of the patient financial impact. This means working with patients to make payment plans work, or developing alternative treatment plans that both provide the necessary care and are affordable for the patient.
  • Real-time Information. Old revenue management systems often generate outdated reports that lack accurate coverage information. Being able to access real-time information with the click of a mouse enables providers to intervene immediately to facilitate problems that might arise such as the sudden change in insurance reimbursement plans. 

However, simply buying new technology might not be the best quick fix solution for a healthcare provider struggling to survive in the marketplace.

While the overall scope of revenue solutions is continually changing to adapt to this new emerging environment, such a change is gradual. For obvious reasons, healthcare providers can be reluctant to undergo an immediate conversion simply due to the scope and financial commitment such new adoption projects require. It can be smart to start small, tackling one project at a time. For many providers, this means focusing on finding ways to meet EHR meaningful use requirements, before going on to readjust their revenue cycle management in a more significant way.

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