Top 5 Roadblocks in Healthcare Revenue Cycle IT
LightSpeed Technology Group has developed and managed software for healthcare organizations for over 17 years. During that time, we’ve witnessed great change in our industry. However, these advances aren’t perfect. In many cases, rapid change has created inefficiencies within healthcare systems. In this article, we’ll dive into the top five sources of inefficiency in the world of healthcare IT, the causes and ways to prevent and correct them.
- Counterintuitive Workflow
A hospital’s revenue cycle should be structured with the goal of consistency across the entire process. Unfortunately, many healthcare organizations suffer from hiccups and bottlenecks in revenue cycle. Front-end verification often suffers from omissions and errors in patient information and insurance eligibility status, leading to payment denials and revenue loss. Issues with EHRs disrupt workflow when patient data cannot be shared easily among clinical staff. To eliminate these issues, provide front desk staff with the proper tools and training to avoid errors and omissions. Ensure your EHR is built to suit your organization and that clinical staff receive proper training to use it effectively. Workflow oversight tools can help ensure consistency in deficiency reports. Accurate reporting informs billing staff about documentation issues that prevent proper coding and billing.
- Improper Implementation
EHRs were designed to improve efficiency and reduce costs. Lately, it seems these systems are increasing rather than decreasing administrative costs. While the EHR system itself is sometimes to blame, improper implementation can wreak havoc on an EHR’s effectiveness. Incomplete transfer of data to the EHR and improper training are common problems hospitals face during the implementation process. These issues lead to usability problems and potentially harmful consequences. For a successful implementation, hospitals must strategically build the EHR, employ project managers and subject matter experts, and engage key members of the organization to assist with build, end-to-end testing, user training and rollout components.
- Poor System Integration
Another common inefficiency is the lack of integration of systems within the revenue cycle. Healthcare organizations often have multiple systems in place, each requiring manual intervention to transfer documents and data from system to system. This practice leads to processing delays, increased labor expenses and unnecessary duplication of work. To resolve this problem, it is necessary to integrate these systems where possible, and enable interoperability, eliminating the need for manual intervention.
- Improper Coding
Claim denials pose a huge threat to a provider’s financial performance and revenue integrity. Unfortunately, many denials are caused by preventable coding errors. The introduction of ICD-10, paired with continual updates to both ICD-10 and CPT codes, makes it critical for coders to have access to proper training, tools and resources to avoid coding denials. Hospitals may also use third-party applications to facilitate coding efforts.
- Inadequate Communication Methods
Finally, communication breakdowns are all too common in healthcare IT. End users often identify issues within a system or application but fail to report findings to the correct personnel. Consider this scenario: A coder notices in analytics that a physician is coding above or below standards. The coder reports this problem. However, the person who receives the report does not have the authority to address the matter. The issue goes unresolved, resulting in ongoing workarounds. To resolve this problem, enlist an ad hoc committee to gather feedback from end users and regularly document the issues that are identified, analyze data, identify trends and establish communication protocols to convey best practices for improvement.
This article was originally published on LightSpeed Technology Group and is republished here with permission.