Compliance as the Cornerstone: Building Revenue, Cutting Costs and Delivering Exceptional Patient Care

In the healthcare industry, compliance is essential to protect providers from potential and significant legal or financial risks. However, compliance can also serve as a cornerstone for building revenue, cutting costs and delivering exceptional patient care.

Increase Revenue

A typical health system sees nearly $5 million in claims denied annually, representing 3.3% of net patient revenue. Improving the appeals process, while ensuring compliance, can help increase revenue by facilitating timely and accurate claims payments. Implementing a proactive appeals management strategy includes identifying and addressing claim denials, tracking appeals and analyzing data to uncover trends and areas for improvement, all within the framework of compliance regulations.

Improving coding accuracy is another way to increase revenue, while also ensuring compliance and avoiding costly penalties. Accurate coding maximizes reimbursements and avoids costly penalties for noncompliance. Investing in trainings for staff can help improve coding accuracy and ensure providers receive the appropriate reimbursement for services rendered, bolstering revenue streams.

In addition to improving coding accuracy, healthcare organizations can use contract modeling and analysis to optimize revenue by simplifying the payer contract renegotiating process. Contract modeling simulates different contract scenarios and assesses the financial impact of each scenario. Through analyzing payment rates, fee schedules and other contract terms, providers can identify instances of underpayment or overcharging, enabling negotiations for more favorable terms. These options not only identify the most favorable contract terms but also mitigate unnecessary administrative costs, ultimately leading to increased revenue and adherence to compliance regulations.

In addition, data analytics can be used to monitor payer performance and identify trends and patterns in claims processing and payment—all of which can be used to help negotiate better contract terms. With a more advantageous payer contract, providers are better positioned to increase revenue, reduce costs and enhance the overall patient experience, all within the bounds of compliance regulations.

Reduce Costs

As healthcare organizations deal with eroding revenues and rising expenses, it’s imperative for them to prioritize both cost reduction and compliance within the industry. Identifying opportunities to reduce costs and improve efficiency is paramount. By consolidating revenue cycle management (RCM) technology vendors, providers can streamline key financial processes which can lead to significant cost savings.

Partnering with an End-to-End platform partner who can provide a comprehensive suite of RCM solutions, including eligibility verification, claims processing, payment posting and denial management, can be instrumental in achieving these goals. Consolidating solutions into a single platform reduces the complexity of managing multiple revenue cycle vendors, while helping to ensure compliance with regulations and optimizing cost-effectiveness.

Furthermore, integrating robotic process automation (RPA) technology can drive even greater efficiency, improve claims accuracy and contribute to cost reduction. RPA can automate repetitive tasks, such as claims processing and billing, which can decrease the need for manual labor and empower staff to focus on higher-value tasks. By harnessing the power of RPA, providers can reduce costs, maintain compliance and enhance overall efficiency.

Combining the consolidation of RCM technology vendors with the implementation of RPA, can promote a dual benefit of reducing costs and helping to maintain compliance. This approach not only optimizes financial performance but allows providers to allocate resources more effectively, and ultimately improve patient care and experience. Compliance and cost reduction can go hand-in-hand and adopting efficient technologies and streamlined processes is key to achieving these objectives.

Improve Patient Experience

Price transparency has become increasingly important with many states and federal regulations mandating that clear and accurate price information is provided to patients. Compliance industry standards around price transparency, including providing machine-readable files, can build trust with patients and improve their experience.

To comply with industry standards around price transparency, healthcare organizations must provide information on the cost of services, including patient financial responsibility on any out-of-pocket expenses. Providers can now use technology to automate the price estimation process and give patients real-time estimates based on their insurance coverage and other factors.

In addition to providing price estimates, machine-readable files that contain pricing information for all services must be shared. This file must be in a format that can be easily read and processed by computers, allowing patients to compare prices across different healthcare providers.

Price transparency is important not only for compliance, but also for meeting your patients’ needs. Patients want to know how much they owe for services, and accurate price estimates can help them plan and budget for their healthcare expenses. By providing accurate price estimates, providers can build patient satisfaction and trust with their patients.

Greater transparency also helps improve revenue management by reducing the number of patient inquiries and disputes related to billing and payments. Providing clear and accurate price information upfront and throughout the patient journey improves efficiency and reduces administrative costs.

Compliance is essential in healthcare, but it can also serve as a cornerstone for building revenue, cutting costs and delivering exceptional patient care. With the right tools, it’s possible to achieve these goals while maintaining compliance and providing high-quality patient care.

Learn how FinThrive can help your healthcare organization address RCM compliance issues with a single platform.