Revenue cycle reporting methodology has changed over the last few years. Between the pandemic and unprecedented staffing challenges in the healthcare space, revenue cycle leaders are forced to ensure they have real-time access to detailed reporting and results to avoid lost revenue.
Here are the current revenue changes and strategies providers should use to report revenue cycle results properly.
COVID Changed The Healthcare World
Healthcare changed drastically during the COVID-19 pandemic. Revenue numbers dipped, and while some recovery has occurred, as with many industries working to recover, the ripple effects are still felt today.
Before the pandemic, providers struggled with reimbursement on the payer and patient sides. COVID has only compounded these issues and made full reimbursement more vital than ever.
The most significant trend resulting from the pandemic was the loss in revenue.
Many practices saw their collections drop due to safer at home orders and the inability to see patients. While some providers were able to implement telehealth, it was not enough to make up for seeing a full schedule of patients.
After being forced to close, practices had to let go of staff. Ultimately, this resulted in a lack of A/R follow-up, leading to lost reimbursement and increased uncompensated care.
The Problem with Current Metrics
While the healthcare industry is still scrambling to recover, significant changes in metrics are still happening.
Billing and payments have started seeing an upturn, although there was a lag for a bit. In some cases, the NCR and the GCS have decreased from 150% to about 60%. Of course, this confused many people since it went from an upturn while these other rates are still at a low point.
Financial leaders, CFOs, and those in charge of the revenue cycle were shaking their heads, wondering what exactly they missed. They sit there, poring over the metrics, trying to figure out what to do.
Along with these skewed metrics, there were other changes too.
During the first quarter, many COVID-related denials occurred, especially for non-covered services deemed a medical necessity. We also saw a significant difference in prior authorization and eligibility, which lowered due to the E&M code changes implemented at the beginning of 2021.
Then, during the middle portion of 2021, providers started to recover. However, aging A/R and denials continued to be a challenge.
While some healthcare providers leveraged their data and started attacking their aging A/R, and while some are making progress and lowering write-offs, others struggle to embrace and understand the data shifts. Some providers are focusing on the wrong metrics leaving them with an incomplete financial picture. The result is missed reimbursement and an increase in write-offs.
The Future—Investment In Data and Analytics
There is a surge in healthcare for better data and analysis. Providers have relied too long on excel spreadsheets and basic reporting in their practice management system.
Data structure and better insights into the revenue cycle are a big trend we’re seeing. Providers are realizing that to take control over their reimbursement, the answer lies in their date.
The investment into analytics tools is not just for proper metrics to provide a realistic look at how a business is performing but also in different ways to offer accurate data management and growth.
Infinx Can Help
If you find yourself struggling with proper data metrics and looking to see how to structure your data better so you can monitor metrics and KPIs while getting payments promptly, we can help.
Schedule a call today to learn what you can invest in your healthcare practice so you can grow and meet target KPIs.