Staying ahead of compliance and revenue challenges is critical to the success and sustainability of any healthcare organization. The question is: can your vendor effectively highlight the top compliance and revenue risks your organization faces?
Here are three core competencies that today’s revenue cycle management (RCM) platforms need to offer:
1. Benchmarking: Know Where You Stand
Benchmarking is a powerful tool that enables healthcare organizations to compare their performance against industry standards and peers. It’s not enough to operate in isolation; understanding how your organization measures up is key to identifying areas for improvement.
An RCM vendor should be able to leverage comprehensive benchmarking tools that allow you to:
- Identify outliers: Quickly spot areas where your organization deviates from the norm, whether it’s in billing practices, documentation, or coding accuracy (overcoding/undercoding).
- Assess performance: Measure your compliance and revenue integrity efforts against those of similar organizations, such as how much you refund or retain when targeted by external auditors (RAC, MAC, TPE). This gives you a clear picture of where you excel and where you may need to focus more attention.
- Drive improvement: Use benchmarking data and insights to help with education and corrective action for your providers, coders, and other revenue integrity stakeholders.
2. Predictive Capabilities: Stay One Step Ahead
In healthcare, the ability to predict potential risks before they become actual problems is invaluable. Predictive analytics helps healthcare organizations anticipate future trends, identify patterns, and take proactive measures to mitigate risks.
An RCM vendor should be equipped with predictive analytics and AI capabilities that empower your team to:
Forecast compliance risks: Predict areas of non-compliant billing based on historical data, enabling you to address issues before they escalate.
Identify revenue vulnerabilities: Pinpoint potential revenue leakage or underpayment risks by analyzing anomalous patterns in billing and coding data.
Allocate resources effectively: Prioritize audits and compliance checks in high-risk areas, ensuring that your resources are deployed where they are most needed.
3. Payer Policies: Navigate the Complexities with Confidence
Navigating payer policies is one of the most complex aspects of healthcare billing and revenue cycle management. Payers frequently update their policies, and staying on top of these changes is crucial to avoiding denials, minimizing revenue loss, and ensuring compliance.
Your RCM vendor should provide continuous monitoring of payer policies, ensuring that you can:
Stay updated: Receive real-time alerts on policy changes that impact your organization, so you’re never caught off guard.
Mitigate denial risks: Identify potential denial triggers before claims are submitted, reducing the likelihood of revenue loss due to non-compliance with payer requirements.
Ensure compliance: Align your billing practices with the latest payer policies, ensuring that you meet all regulatory and contractual obligations.
Incorporating the above three capabilities positively impacts the bottom line and ensures steady cash flow.
Partner with a Vendor That Empowers You
Your vendor should be more than just a service provider—they should be a partner in your success. At MDaudit, we believe that our continuous risk monitoring platform, combined with robust benchmarking, predictive analytics, AI capabilities, and in-depth knowledge of payer policies, empowers healthcare organizations to highlight and address the top compliance and revenue risks effectively.
By partnering with MDaudit, you can ensure that your organization is not only compliant but also positioned for financial success. Contact us today to learn how our platform can help you stay ahead of the curve.
