Like all private companies, healthcare organizations such as hospitals and clinics must look after their revenues. A healthcare revenue cycle consists of all administrative and clinical activities that lead to the management and collection of revenues for medical services provided. Needless to point out, the efficiency of everyday operations directly leads to increased revenues. It is widely known that using EHR systems improves hospitals’ clinical and administrative efficiency. So, it took a little while for providers to merge the twin benefits of EHR revenue cycle management.
Repeated surveys and research have revealed the direct correlation between using an EHR/EMR and improving the overall quality of patient care. Needless to point out, this directly results in an optimization of the overall process of revenue cycle management. We will elaborate further on the connections between EHR and medical revenue cycle management.
How Does EHR Software Improve Medical Revenue Cycle?
When patients walk into a clinic for the first time, an elaborate series of events happen between the patient leaving and the provider getting paid. Let’s look at those events in detail.
When patients walk in, their insurance is verified, after which the provider will see them. During the consultation, the entire doctor-patient encounter is recorded, following which the medical services rendered are coded. Subsequently, the entire clinical visit is billed, and the claims are generated to be sent to payers. The patients pay whatever amount in out-of-pocket payments they need to.
But this process has its inefficiencies. Mistakes by any staff might result in the provider’s revenue loss. Errors in insurance verification could result in the services not being covered by the insurance payer. A mistake in coding would result in the claim being denied, resulting in loss of reimbursements and denial management activities. Denied or rejected claims are some of the biggest reasons for the loss of revenues for individual providers with private practices and hospitals.
The presence of an EHR or EMR software eases the entire revenue cycle management process. Many medical records solutions also possess features to allow people to schedule appointments online. So, the clinic or hospital staff can finish the patient intake procedure before the patients even arrive for their appointment. Moreover, thanks to innovations in automated healthcare solutions, the front office staff can verify health plans in minutes with a few clicks on a screen. This ensures that the patient is covered for the consultation and the subsequent services that might be provided.
Following verification, the provider can document the clinical encounter on the EMR, which is later used for charge capture by the nurses or administrative staff. Subsequently, the EMR or EHR also enables automated coding, minimizing the need for human intervention. This is beneficial because it minimizes coding errors, which are among the biggest reasons for claim denial.
After coding has been completed, the claims are generated and scrubbed. The feature of claims scrubbing helps to ensure that there are no minor errors in the claims. The staff can carry out coding and claims scrubbing using the features included in the medical records software. This removes the necessity for manual activity, improving the speed and lowering the chances of errors.
The payments are processed efficiently when the claims are sent to the payers and reimbursements are received. This entire flow of activities is largely automated thanks to an EHR integration with the health information system. The activities surrounding billing require access to patients’ data. The treatments undergone, tests taken, and all the medical services received can be accessed in the medical records. So, integrating EMR software allows the non-medical staff to fetch this data to carry out their activities. As a result, everything from verifying insurance, coding, and claims is faster and more accurate. This eventually leads to higher revenues and reduced denials.
In addition to higher productivity with fewer errors, using an EMR or EHR for billing also boosts efficiency. A relatively smaller staff at a medium-sized clinic can handle the billing of numerous patients without hassle. So, the overhead needed for the staff is also lowered in the long run. So, it will be a smooth process to associate an EHR with an optimized medical revenue cycle.
Can EHR Improve Revenues For Telehealth Services?
Telehealth leverages digital and communication technologies to help doctors provide medical services remotely. The idea of telehealth solutions is not new, but the Covid-19 pandemic took it from conception to reality in under a year. It allowed people to access their providers remotely from the comfort and safety of their homes. An EMR or EHR integrated with a telehealth platform streamlines the whole process of care management.
When patients are in a virtual consultation over a telemedicine application, an integrated EHR allows doctors to access the patient’s medical history. This helps providers know their patients better and make informed diagnoses. In addition to helping to improve remote care, an EHR also serves the same functions as it would for regular in-person care. Providers can make notes on the medical records software during the online consultation and prescribe medication and tests.
Following the consultations, the services can be billed similarly to regular in-person clinical encounters. The necessary data for charge capture, coding, and claims generation can be obtained from the EHR incorporated within the telehealth application. So, providers who do see patients virtually can receive reimbursements accordingly.
It is important to note the necessity of EHR revenue cycle management in the case of telehealth. As the healthcare industry continues to adopt digital technologies, telehealth solutions can serve as the medium for conventional care and remote patient monitoring. However, medical revenue cycle management in the case of telehealth will only function with EHR integration. The most important feature of medical records software is the ease of data exchange. It allows non-clinical staff to fetch the necessary information for billing. It won’t be an exaggeration to say that telehealth service is only possible through an EMR/EHR integration.
Not only does software for medical records improve the quality of patient care, but it also helps providers get paid. In other words, EHR revenue cycle management activities support digital transformations brought about by telehealth adoption.
The Covid-19 pandemic catalyzed the healthcare industry into accepting telehealth solutions. Furthermore, advancements in healthcare cloud computing and wearable medical technologies are expected to bring about more changes by the end of this decade. Nevertheless, billing would need to catch up to these changes, and the entwined functionalities of EHR revenue cycle management will play a big role.
Cost and accessibility remain major problems with healthcare in the United States. Telehealth technology is seen as a great way to address these concerns. Considering this, EHR development must catch up to the ongoing changes and help serve the stakeholders better.
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Written by Riken Shah linkedin
Riken's work motto is to help healthcare providers use technological advancements to make healthcare easily accessible to all stakeholders, from providers to patients. Under his leadership and guidance, OSP Labs has successfully developed over 600 customized software solutions for 200+ healthcare clients across continents.