The payments will contribute up to 5 per cent to healthcare systems’ bottom line
Hinduja Global Solutions (HGS) recently announced it has recovered $1 billion in denied insurance payments on behalf of healthcare systems, a major milestone in what are some of providers’ toughest claims.
“As macroeconomic headwinds continue to impact the US healthcare market, providers often struggle to walk the fine line between the push for healthier patient outcomes and an unsustainable cost structure. At the same time, the provider revenue cycle is becoming increasingly complex. Providers need a strong partner to help them pursue smaller insurance claims properly and recover payments that go right back to their bottom line. We’re thrilled to have reached the $1 billion milestone and recover some of the toughest claims for our provider customers,” said Dan Schulte, Senior Vice President, HGS Healthcare.
The average hospital costs must fall 24 per cent by 2022 in order for healthcare systems to break even, a recent Black Book Market Research survey found. By getting denied insurance claims adjudicated, properly appealed and collected, HGS is able to contribute up to 5 per cent to healthcare systems’ bottom line.
Having strong relationships with both payers and providers, HGS brings unique and in-depth expertise to provider revenue cycle management. To-date, the company has collected more than $3 billion in accounts receivable on behalf of healthcare systems.
Revenue cycle management, better known as RCM, is a business process that allows healthcare companies to be paid for providing services. For most healthcare service providers, RCM is available right from the process of pre-registering a patient all the way through the collection of final payment. Efficiency and time management play vital roles in RCM. A healthcare provider’s choice of electronic health record (EHR) can often be largely centered on how its RCM is deployed.
The implementation of RCM in a particular healthcare company is a lengthy process. The company has to submit all the documents of its patient to the in-house staff or RCM vendor, who will then code the charts according to the ICD-10 CM. Afterward, the claims are posted, submitted, and adjudicated by the payer. If a claim is rejected, steps are taken to resubmit and adjust it before the deadline of appeal. Then the patient cycle is initiated if there is a patient responsibility portion following adjudication. Nowadays, numerous RCM vendors are providing coding benchmarking, managed-care contracting, analytics, and coding education services to capture all the earned revenue for a practice. No matter the size of a hospital, health system, or practice, failure to prioritize and maintain revenue collection efforts and RCM can hinder growth, create an uncertain financial failure, and increase operational risk.
As per Fortune Business Insights the market is anticipated to reach USD 216,990.6 Million by 2026, exhibiting a CAGR of 12.4% in the forecast period. But, the RCM market was valued at USD 86,811.4 Million in 2018.
Why is Revenue Cycle Management a Complex Procedure?
The focus of several healthcare service providers is on offering top-notch care to their growing patient population. However, attention must also be paid to the financial solvency of the business to make sure that a hospital will be able to provide the same level of care in the upcoming years. Doctors and physicians are persistently faced with the challenge of providing cost-effective care to the patients while witnessing annual increase in administrative and care-delivery costs. Maintaining healthy accounts, preventing and reducing unpaid claims, reducing inefficient billing and coding processes, and enhancing point-of-service collections can severely impact profit margins.
The task of preventing unpaid claims to witness the greatest profit margins is strenuous, considering the nature of healthcare. The healthcare sector is complex as the price to offer services is shouldered by the organizations even before those services are paid either by the patient or the insurance companies. But the claims process is time-consuming. It can take months before a bill is paid in full. According to a survey, more than 95% of medical practice leaders reported inadequate billing processes. The majority of the leaders executed backup efforts to resolve the process by the end of the year. Besides, an inclination towards direct patient responsibility with high deductible health plans from commercial payer reimbursement supports the fact that healthcare service providers must closely examine their RCM and evaluate the methods to achieve multiple benefits.
Source: https://www.fortunebusinessinsights.com/industry-reports/revenue-cycle-management-market-100275