Revenue leakage — the inability to collect earned revenue — is just one of many challenges facing today’s academic medical centers (AMCs), and the healthcare industry more broadly. Fifteen cents of every healthcare revenue dollar goes towards revenue cycle inefficiencies, claims processing, billing, bad debt and more according to a McKinsey & Company study. But by putting the proper systems in place, AMCs can convert uncompensated care into steady revenue streams, improve efficiencies, and ultimately boost the bottom line. Here are a few best practices to help stop revenue leakage:
The constant changes and shifting expectations currently facing the healthcare industry have spurred a digital revolution that is long overdue. Big data technology offers healthcare providers the opportunity to improve current processes while at the same time helps mitigate the risk of revenue leakage. By implementing advanced systems like insurance discovery software that utilize big data and advanced algorithms, AMCs can efficiently capitalize on the information available at their fingertips — uncovering hard-to-find coverage and securing reimbursement for claims previously deemed to be uncollectable. Through the use of big data technologies, hospitals and other healthcare facilities have been able to reduce costs by more than 10% and grow revenue by 30 percent.1
Different insurers, new or incorrect policy numbers, non-covered service restrictions, and billing system and process errors can all prevent accounts from being correctly paid. And since AMCs often perform rare, complex procedures, they are at an especially high risk for billing errors resulting in claim denials. By uncovering breakdowns within the current billing systems or processes, AMCs can lower the risk of rejected returned or denied claims, as well as help ensure claims are resubmitted in a timely manner in order to remain eligible for reimbursement.
Despite their best efforts, today’s hospitals are leaving billions of dollars of revenue on the table. Many hospitals scrub patient data and review errors internally, either relying on a largely manual process, or attempting to build and implement their own discovery tools. Both of these processes are extraordinarily costly — in both time and money, vulnerable to error, and pull employees away from other critical tasks. While significant opportunities to convert earned revenue into realized revenue exist, many are only possible through implementation of sophisticated technology available through best-in-breed revenue protection solutions. AMCs should partner with a trusted provider known for superior service in order to most efficiently and cost-effectively capture that lost revenue.
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1Big Data in the Healthcare & Pharmaceutical Industry: 2017 - 2030 - Opportunities, Challenges, Strategies & Forecasts Report by SNS Research