The US healthcare system has a lot of problems associated with it. These issues obstruct the healthcare system from realizing its full potential.
Problems like patient identification errors, revenue cycle issues, and financial losses are quite common. However, let’s talk about a problem that everyone is working hard on fixing- the patient experience and how it is affected by the revenue cycle.
The experience patients receive within the hospitals and education regarding the healthcare providers are only emphasized on- financial experience is ignored. Thus, the revenue cycle has been neglected for a long time.
Since patient financial responsibility (the amount of money patients pay for medical services) is increasing, patents are becoming more aware of their expenses. They are searching for better value for money.
Revenue Cycle Optimization
For this, revenue cycle optimization is crucial, so that the patients do not receive any unwanted claims- which improves the overall patient experience.
According to the Kaiser Family Foundation, any given family spends around 11% on healthcare services- from which one-fourth is consumed by out-of-pocket costs such as deductibles and co-payments.
Thus, as it is evident that patient expenditure on healthcare is over thousands of dollars and consists of out-of-pocket costs, the providers need to ensure that they provide not only exceptional healthcare experience but also a smooth and accurate financial experience.
A hospital’s revenue is dependent on the services it provides to the patients- the better the services, the better the revenue, and vice-versa. Deloitte also backed this up- hospitals that offer better patient experience have higher returns than those who do not.
The report focuses on how vital patient experience is. It contains both the experience received within the premises and the experience patients receive in terms of financials. This is why many healthcare providers are now focusing on optimizing the revenue cycle within their organizations.
What are the problems which hamper the revenue cycle?
There are a lot of issues that create an unhealthy revenue cycle for any given hospital. Topics such as registration, coding or billing errors, unverified insurance, underpaid, and denied claims are quite common.
Many of these occur due to patient identification errors. A patient mis-identification occurs when a hospital staff pulls up the wrong EHR (electronic health record).
Whenever a patient goes for treatment, the EHR is needed for further assessment. When the hospital staff searches for the record, he/she sees that it can be quite challenging to identify the correct record- common names, thousands of medical records, and other issues slow down the identification of the accurate record. The staff either creates a new record to save time or else creates a new record.
If a new record is created for an existing patient, it generates a duplicate medical record. However, if the staff merges two such records, it creates a medical record overlay. Both are quite harmful and severely impact patient safety.
Patient identification errors make up one of the biggest problems of the US healthcare system- anyone who follows the news knows that patient identification is quite severe as well as a common issue. It causes around 35% of the denied claims, which directly affect the revenue cycle- generating about $5 million losses per year.
These denied claims are due to the bills being sent to misidentified patients- impacting the overall patient experience since financials are a part of the experience.
How can health systems improve revenue cycle management?
Healthtech has already come up with several solutions to the problems being faced by hospitals. Since patient misidentification causes a significant number of denied claims, if the former can be solved, the latter can also be reduced.
Fortunately, there is an innovative health-tech solution which many healthcare providers are using. Right Patient is a biometric patient identification platform that several hospitals are using to tackle patient identification errors.
It uses biometric data such as irises or fingerprints to lock the patients’ medical records. This ensures that the correct patient is identified every time the patients come for treatment.
It also prevents medical ID theft as well as reduces denied claims- since the right patient is determined using their biometric data, there is no chance for billing the wrong patients and receiving denied claims. Novant Health and Terrebonne General Medical Center are using it and are enjoying reduced denied claims.
As a result, they have improved their revenue cycle as well as the patient experience- patients get identified within seconds; thus, no waiting times for identification.
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Author: Noman Ahmad
