By Steve Gallion, MedTrainer
In order to run a successful practice, today’s healthcare organizations need qualified providers and to maintain a consistent revenue flow. But amid rising operational costs, complex regulatory requirements and high staff turnover rates, this is easier said than done—particularly for those relying on manual administrative processes.
Staff often become overwhelmed, juggling front-end office duties with critical back-end functions like provider credentialing, payer enrollment, claim submissions, patient billing and HR responsibilities. This constant balancing act not only leads to inefficiencies and costly errors, but also detracts from the primary purpose of any practice: delivering quality patient care.
Medical practices struggling with these challenges can now employ the latest software solutions to reduce administrative strain, improve practice efficiency and maximize financial performance. By leveraging technology in the following three areas, practices can transform their operations and achieve full revenue potential:
- Human Capital Management
An aging population and a rising shortage of physicians and nurses have driven intense competition for skilled staff. It is now more important than ever for healthcare organizations to recruit, retain and foster the best personnel resources available. This includes offering competitive pay and creating opportunities for professional growth—while remaining within budget.
Rather than rely on already overburdened administrators to execute these HR duties, practices can invest in technology for human capital management (HCM). Today’s HCM software can do far more than facilitate payroll and track benefits. Just one system can provide critical human resource services that would have traditionally required an entire HR department.
Practices should look for a solution that allows them to:
- Streamline recruiting, hiring and onboarding
- Optimize workforce planning
- Budget employee salaries and benefits
- Track required employee trainings, certifications and licenses to maintain compliance
- Monitor individual performance and career trajectories
Ultimately, the goal of human capital management is to maximize the output of personnel. Practices can utilize HCM software to find the right people and build cohesive teams within the work environment, resulting in greater efficiency and higher level of patient care.
- Credentialing Management
Once an organization has obtained qualified providers, they must initiate a solid revenue stream through proper credentialing, enrollment and privileging. However, healthcare organizations have traditionally relied on patchwork methods involving paper files, Excel spreadsheets and Outlook calendar alerts to manage all document acquisitions, verifications, payer applications and renewal dates.
Today, this traditional credentialing format is too time consuming and error prone. Incomplete documentation, mistakes and missed deadlines lead to reimbursement delays that quickly compound into serious revenue flow problems. For example, consider a provider who misses a re-enrollment request from a major payer and does not submit his recredentialing paperwork within the required time frame. As a result, the provider is then disenrolled from the insurance panel—which winds up costing him nearly 60 percent of his business. This type of error, especially on a healthcare system scale, can be crippling.
Further, traditional credentialing departments are limited in their capacity. So, if an organization is trying to increase profits by adding additional providers, they must also add more credentialing staff. Any new revenue will be offset by the personnel costs required to service those new providers.
Instead, practices can facilitate and protect revenue flow with automated credentialing management software. These solutions alleviate the administrative burden by:
- Organizing electronic formats of all documentation required for each provider in one central location
- Automatically alerting administrators when information is expiring, expired or missing
- Automating payer enrollment, including universal population of payer forms, to quickly and accurately submit applications
- Tracking application statuses to eliminate time-consuming, follow-up phone calls
And by leveraging automation, practices can easily scale their credentialing capacity as their business grows, significantly improving profit margins without cutting into new revenue streams.
- Revenue Cycle Management
In addition to building a strong workforce and solid financial foundation, medical practices need an effective system to enhance, maintain and forecast consistent revenue flow. Practices can implement revenue cycle management (RCM) software to maximize payments, reduce reimbursement time and alleviate the strain on administrators.
RCM software can:
- Streamline patient registration, scheduling and check in
- Collect proper copays at the time of the patient’s visit
- Prevent billing and coding errors to reduce claim denials
- Easily track the progress of unpaid claims
This level of automation frees staff from time-consuming paperwork, so they can better engage with patients and focus on other business goals. RCM software also can provide performance reports so that practices can quickly pinpoint potential issues, forecast profits to make better financial decisions, and ensure no potential revenue is left on the table.
Software Integrations For Maximum Efficiency
Many software solutions in the healthcare marketplace today offer easy integrations with other trusted systems. Practices should look for credentialing, HCM, and RCM solutions that directly link with one another for a seamless, convenient user experience. This coordination eliminates duplicate data entry, streamlines system management and improves overall efficiency.
With the trifecta of credentialing management, human capital management and revenue cycle management working flawlessly together, medical practices are set up for financial and clinical success.
About The Author
Steve Gallion is cofounder and CEO of MedTrainer.