Adapting to a Transformed Revenue Cycle

OneCare Solutions Services

Revenue Cycle Management is no longer business as usual. Healthcare reform has forced a transformation of the processes and outcomes. High deductible health plans are replacing traditional low deductible plans, placing greater financial burden and responsibility on the patient. Healthcare professionals face the challenge of managing patient satisfaction amidst a population that often does not understand health insurance coverage. They are faced with angry patients who are unable to pay the unexpected out-of-pocket expenses.

Healthcare facilities and providers must recognize the need for change. An assessment of the effectiveness of their current infrastructure in today’s healthcare environment is important for survival and success. Patients often rate healthcare services according to their financial experiences and choose their care providers accordingly. The time to take action is now in order to identify areas where change is necessary. The steps listed below will help establish goals and a plan to achieve them.

  • Build a team that will move the project forward
  • Set sustainable goals and reasonable expectations
  • Conduct an analysis of current workflow, processes, procedures and policies
  • Identify gaps
  • Engage managers and staff
  • Redefine roles and positions
  • Develop matrices to identify payer terms
  • Educate staff
  • Communicate – monitor – track – feedback

The focal point of Revenue Cycle is shifting from the back-end to front-end. Helping patients make wise financial decisions about their healthcare begins with a facility or provider who is aligned with the environment of healthcare reform. In order to accomplish this, the service provider must have the ability to present health benefit information and estimated out-of-pocket expense to a patient prior to the date of service. This requires aggressive engagement with the patient during the process before they receive higher-than-expected bills.