Hospitals around the nation flourish through a focus on various goals and metrics that ensure they are maximizing their revenue and providing the best service for their patients. Healthcare organizations as a whole experience challenges with revenue cycle management (RCM), but the demands placed on rural hospitals, such as physician shortages, unique patient demographics, and a higher level of poverty and mortality rates, contribute to operating on negative margins. Facing these challenges requires a deep understanding of billing and revenue cycle management.
The Importance of Billing and RCM Services for Rural Hospitals
Hospital billing services vary from one organization to the next, and rural hospitals are no exception. Maintaining a robust revenue cycle is imperative to ensure that every aspect of billing is captured, from the simplest evaluation and management (E&M) codes to the more complex with surgery and specialty services.
No matter the service, rural hospitals tend to operate within negative margins due to a lack of resources, lower reimbursement rates, a challenging patient population, and a lack of attention to the full revenue cycle – not just when the patient shows up for a visit.
Billing and revenue cycle management services are all-encompassing. Comprehensive billing and RCM service begin before the patient arrives, with the negotiation of payer rates (aside from the standard Medicare and Medicaid rates), provider credentialing, and full-price transparency for patients. The tail end of these services completes the cycle – claim submission, tracking Accounts Receivable (AR), and analyzing the data, metrics, and goals set forth by the organization. The importance of each cog in the wheel of a rural hospital’s billing and RCM service are critical, and ultimately means the difference between operating within – or under margin.
The Challenges That Rural Hospitals Face When It Comes to Billing
Location is not the only challenge that rural hospitals face. Patients in rural eastern Kentucky, for example, have one hospital that services multiple counties with a high rate of patients on Medicaid and other state assistance programs. Residents in rural New Mexico have limited choices for critical care – driving one or two hours to the closest hospital. One of the most demanding regions in the United States – Alaska, battles the challenges of extreme weather, rugged terrain, and remote villages, with air travel as the only option for many patients to receive specialty care in Anchorage.
Aside from location, higher rates of poverty and unemployment, an aging population, and higher instances of chronic conditions that increase the cost of care – all contribute to the challenges a rural hospital faces with billing and revenue.
Rural hospitals also provide a higher rate of charity care, resulting in uncompensated care. Patients in these areas may rely on state or federal government insurance plans and are unable to pay out of pocket for non-covered services. This reality heightens the burden for rural hospitals – owed money is never paid – even with payment plans, or patients just don’t have the ability to pay.
Rural areas are home to a considerably high number of people – but the number of physicians employed in these hospitals is much lower, reducing access to care and continuing the cycle of higher costs of care for unhealthy residents.
Hospital billing and collection services depend on effective guidance from the experts in the revenue and billing departments, but because the direction on optimizing RCM is geared towards larger organizations, even those that are non- or not-for-profit, they benefit from a seemingly more robust RCM.
Healthcare consultants, however, can provide solutions to help offset these challenges with value-based reimbursement, which helps to lower the cost of care and payment plans that encourage patients to make timely payments. The result is the capture of lost revenue and a path toward healing a broken revenue and billing cycle.
How Outsourcing Billing and RCM Services Can Help Rural Hospitals Overcome These Challenges
Outsourcing medical billing and revenue cycle services is a proven method of creating efficiency in any healthcare organization. Hospital revenue cycle management challenges are more than burdensome for a rural hospital, as they have a need to focus on recruiting physicians, improving access to care, and reducing the cost of care for patients with chronic conditions and limited means to pay for specialty care.
Outsourcing billing and RCM services for a rural hospital means that every component of the billing cycle is captured, from patient registration to patient collections. With a dedicated team of billing experts, rural hospitals will see a higher rate of clean claims, a decrease in rejections, and a higher rate of reimbursement that is otherwise lost without a team of billing experts.
A significant plus is adding the revenue cycle management piece, which provides a strong focus on analytics and goals for the organization. More importantly, on the front end – before the revenue cycle even starts, an outsourced team can focus on the peripherals – physician enrollment and contract negotiations. The complete picture of billing and RCM comes full circle with a committed team of experts in the field.
How to Choose the Right Billing and RCM Service Provider for Your Hospital
Hospital revenue cycle management and medical billing services are specialized in multiple areas, from simple office visits to complex surgeries, and understanding the characteristics of a functional revenue cycle. Choosing a billing and RCM service provider must stem from not only improving the billing processes and increasing revenue but also from improving the overall patient experience.
When hospital operations are streamlined, patients have better access to care and they develop a higher level of trust with the people who provide that care. Billing and revenue cycle management are not immune to the patient component of healthcare. They are essential for providing patients with the services they need – care with a high level of quality, ease of access, and creating a billing structure that helps patients to understand every part of their health, including the financials.
When your hospital decides to transition to an outsourced service provider for billing and RCM, focus on the following:
- Company employs certified billers and coders
- Number of years in business
- Number of claims processed per year
- Rejection rate
- Payment rate
- How many specialties or services the company provides
- What technology platforms the company is familiar with (EHRs and analytics software applications)
- Services available for patients
- Revenue cycle management tools, training, and analytics available
Your hospital’s revenue cycle keeps the doors open and should provide more than cash flow and an operating margin. The right billing and RCM team can give you the flexibility to focus on your mission and vision, and make the patient experience the best it can be.
Questions About Hospital Billing Services? Contact Coronis Health Today!
Outsourcing hospital billing services is a choice that many hospitals have made to accomplish the goal of improving efficiency, streamlining processes, and increasing cash flow. Create more flexibility for your organization by choosing Coronis Health for your hospital billing and revenue cycle management needs.
When you want more for your patients and your hospital, outsourcing is the best option and removes the burden of dealing with the challenges of managing what Coronis can manage for you. If you have questions about how you can improve your organization’s billing and RCM, call Coronis Health today.