Enforcement by the concerned health insurance regulatory bodies in terms of reimbursement protocols forced healthcare industries, medical practitioners, and all entities directly involved in treating patients to adopt value-based reimbursement models rather than volume-based care. Regarding value-based care reimbursement, medical practitioners would get reimbursement for the quality care they provided to their patients instead of the number of patients they treated and the number of procedures providers performed on a particular patient. In the financial reimbursement process, there are so many factors that directly affect the patient’s outcomes, but the most important one is how the patient’s data is accessed and processed during the filing, processing, and follow-up of the claims. In the revenue cycle, patient data is accessed by several entities on several levels; therefore, they demand to be aware of their sensitive data, and who is accessing what until the end of the process. If you have an in-house set-up for your practice revenue management, you must define the authentication and authorization protocols regarding data access management. You must ensure that only the authorized personality can access the patient’s required data along with predefined restrictions. If medical organizations lack deploying transparency in their RCM, the patient’s experience would be directly compromised, which means you will not be getting paid for your rendered medical services.
There are several approaches you can go for to deploy a transparent RCM in your practice management department, but Cloud-based health IT systems are in trending right now. As per the BDO’s 2021 Healthcare Digital Transformation Survey, over three-quarters of healthcare organizations have already deployed cloud-based RCM solutions in their faculties as it overcomes the significant concerns of medical providers regarding healthcare security since providers are legally and ethically bound by HIPAA to protect patient health information.
The purpose of describing all of this information is to make you aware of how much the regulatory bodies restrict healthcare organizations, medical providers, administrative partners, and every entity that is, directly and indirectly, involved in acquiring the patient’s data to adopt a patient-centric approach, for this, the concept of transparency in practice revenue management does exist and to accomplish this, cloud-based health care IT systems has gained much authority. The benefits of the transparency that these systems provide are not limited to data protection only, but the spectrum of it is vast enough, which surrounds the patient’s experience in all aspects. Therefore, here is a list of some extra benefits transparent RCM provides.
Although it is a primary requirement of legislative authority, CMS for medical organizations to provide clear, accessible pricing information online about the items and services they provide in two formats; one is a comprehensive machine-readable file with all items and services, and the second is in a display of shoppable services in a consumer-friendly format. But the psychology behind this requirement is, again, for the concerned entities to adopt a patient-centric approach in their medical organizations.
Despite that, it is a regulatory act patient demand from medical providers to provide them complete transparency for their ease and security rather than adhere to legislative regulations. Per National Coordinator for Health Information Technology data analytics report, patients of the current era demand more transparency than ever in making decisions about their medical care and the cost associated with it. Similarly, Cedar CEO Florian Otto at HealthcareIT Today, as per their research, revealed that 79% of the patients have the will to pay their out-of-pocket expenses before their visit or at the time of the visit if they are given a guarantee. From the above-mentioned research analytics, it is concluded that medical practitioners must equip themselves with cloud-based healthcare solutions to facilitate conversations around options and affordability.
The collection of these solutions may include real-time prescription benefit tools, like real-time benefit checks (RTBC), Electronic medical records (EMR), such as Cedar complete Healthcare-IT solutions. It would ultimately benefit medical specialties to maintain their financial health by getting maximum reimbursement from the insurance carrier.
It was a traditional and outdated revenue cycle management where there was no regulatory act defined regarding the transparency of patient’s financial responsibility that includes co-pays, deductibles, and coinsurance regarding the covered services, and for this, RCM representatives of medical practitioners had not been ever considered to involve the patient in the workflow process. Ultimately, the patients had to suffer from the surprising bills that required them to pay more than expected.
Now, the healthcare industry has evolved, and laws have been introduced regarding transparency, patient experience, quality of care, etc. Following these legislative regulations, medical specialties and their RCM representative are bound to acknowledge the consumers about their out-of-the-pocket expenses before they get treatment. When this level of transparency is implemented in the reimbursement process, patients receive the bill that costs comply with the estimated one.This improves the overall efficiency of RCM, which comprises plenty of benefits to maintain the financial health of the medical organizations.
The transparency component in RCM directly affects the consumer-to-provider relationship, which hurts the overall financial health of the medical specialty. Deployment of the transparent RCM model in medical organizations requires the authorities to install intelligent Healthcare IT solutions to improve operations and reduce costs and delays to maximize the patient’s experience.
These automated healthcare solutions allow patients to know their out-of-pocket expenses and what medical procedures, medicines, and services their insurance provider will not cover on their first visit or even with remote access. Research analytics and statistics show that patients prefer to get medical facilities from providers who provide IT-based solutions to ease the process. This maximizes the provider-to-consumer relationship to its maximum extent.
Electronic health records are a vital component of the transparent RCM. Although the importance of privacy, confidentiality, and security in medical organizations, integrity and availability of the information is also critical and EMR covers both spectra. It has already been discussed that data exchange between various entities and systems is typical. While exchanging information, data may be manipulated intentionally or unintentionally. In the manual system, there is no way to identify the error; in contrast, EMR solutions have a collection of all necessary tools that alert the clinician about the incorrect entry of the record.
Similarly, if we put light on the availability component of it, electronic health records have redundant components formerly known as fault tolerance systems. In case one component becomes faulty, the system will switch back to the backup component in this way, medical records are available all the time. This gives patients a modernized experience in terms of their data accessibility.
Acquiring a financial partnership with MedsIT Nexus medical billing and coding services is a scalable option that eliminates your recruitment expense and saves up to 70% of general operating costs without losing the quality of care. Additionally, our modernized RCM service will assign a dedicated workforce to process your reimbursement case remaining fully compliant with the legislative regulations. It maintains the financial health of your medical specialty by maximizing revenue collection in the long run.
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