Shots:

• Anas spoke about revenue cycle management in the healthcare sector and the traditional challenges in the healthcare RCM
• He also elaborated on how the evolving technologies can help to overcome the challenges in healthcare revenue cycle management
• The interview shows how Santechture is developing smart AI-based and cloud-based solutions to help healthcare providers develop efficient Revenue Cycle Management

Smriti: To start with, what is healthcare revenue cycle management (RCM)?

Anas Batikhi: The healthcare sector, an ongoing evolving industry on its own, is simply a flowing stream of processes, revenues & valuable health outcomes. Health care, like any other sector needs sustainable funding to deliver on such outcomes. With private and public health insurance benefits and coverage increasingly subsidizing publicly funded services, healthcare providers can no longer thrive without a proper RCM function, expertise, and technology in place to manage and optimize the financial aspects of healthcare services provided by big, medium, and small-sized organizations.

The main aim of revenue cycle management is to ensure that healthcare providers receive timely and accurate reimbursement for the services they deliver while maintaining compliance with relevant regulations. Revenue cycle management involves the entire lifespan of a patient's journey, from initial appointment scheduling to final payment collection.

Traditional Challenges in the Healthcare RCM

To understand how to make RCM work for you as a healthcare provider we must first examine the most prominent challenges that face every healthcare facility balancing the value-based healthcare demands while focusing on their financial sustainability before we delve into how only technology can provide the much-needed support: :

• Insurance Benefits Verification and Patient Eligibility: Verifying patients' insurance coverage and eligibility is a crucial first step in any insured patient journey and is a prerequisite to accurate billing. Getting this process wrong is detrimental to any revenue collections resulting from availing services to the patient. It is today extremely time-consuming adversely affecting a good patient experience and highly prone to errors accounting for at least 30% of overall claim rejections across the region.
• Billing and Coding Complexity: The healthcare sector uses complex coding schemes which call for certified and qualified experts to accurately reflect the medical records of patients though a process called Medical Coding, which is a process involving the translation of the medical record to be represented by assigned diagnoses, health interventions, medication as consumables codes correctly. Coding errors will most likely lead to n claim denials and delayed payments if medical necessity is not correctly represented or coding guidelines and best practices were not followed.
• Claim denials and Rejections: Claim denials are a fact of life, especially given the complexity of the Healthcare encounters and lack of clinical pathways and clear guidelines in part and also because healthcare professionals certain chosen treatment plans may not be viewed as medically necessary or covered by the payer policy causing practitioners to frequently struggle with those challenges and how to appeal, justify and recovery such denials.
• Compliance and Regulatory Changes: The healthcare industry is subject to frequent changes in billing regulations, payer requirements, and compliance standards. Staying updated with these changes and ensuring adherence can be demanding for revenue cycle management professionals
• Shortage of Qualified Talent: Professional coders and RCM practitioners are a rare commodity and in high demand. Filling key positions to manage the RCM operations optimally is often a challenge and outcomes are as good as the team managing, especially in the absence of a well defined processes and systems enforcing best practices and validating each and every transaction and step in the billing process.

Smriti: How is Technology Involved in Facilitating RCM Processes to Curb the Challenges?

Anas Batikhi: Healthcare organizations must adopt a proactive approach to revenue cycle management and continuously improve their processes, and technology is the portal gate to a facilitated and healthier, and connected RCM.

By precisely executing every step within the RCM workflow from scheduling to collecting the account reimbursement balance, healthcare providers stand to reduce significantly their claim denials risk and fast-track their payments. A properly developed and executed RCM system will efficiently apply intelligent automation as well as an enforced business, medical, and coding rules-based process validation to ensure compliance on all aspects of the medical billing protocols clinically as well as financially.

A connected RCM tech links administrative information (such a patients’ personal info, insurance coverage, and other important data to the care they get. Smart technology solutions provided connect the healthcare industry's commercial and clinical segments.

Healthcare firms utilize RCM systems to store and manage patient billing data alongside running smoothly the best quality of healthcare services provided to the patients while maintaining a sustainable revenue through enhanced financial performance.

At SANTECHTURE we have crafted & mastered smart AI and cloud-based solutions that meet the healthcare providers’ RCM demands across a wide variety of touchpoints.

Smart AI-based Reliable Solutions

SANTECHTURE has taken the lead in the region by developing AI market-based automated solutions that guarantee instant enhanced financial performance and elevated quality of healthcare by sorting and solving the traditional challenges and highly demanding processes when it comes to managing revenue cycles in the healthcare industry.

CODEMINE

Region’s first, cloud-based medical coding solution providing support for medical necessity and coding rule edits to support medical billing processes. CODEMINE increases productivity and optimizes clinical coding quality.

THYNK

A fully integrated AI-based real-time rules edit engine that supports medical billing processes for immediate tangible financial value. It detects policy violations in real time at each touch point of the patient’s journey. THYNK assists in patient eligibility & pre-approval checks adding to it medical necessity & documentation checks.

ROBIN

ROBIN is a flow based Revenue Cycle Management Solution that manages the full patient’s journey process starting the moment a patient’s visit is scheduled up to claim payment collection and reconciliation.

QUBE

SaaS EMR powered by smart technologies sophisticated, all-encompassing automated Patient Information System tailored for small and medium-sized healthcare organizations.QUBE is empowered and fully integrated with THYNK, ROBIN, and CODEMINE providing a full range of functionalities for ambulatory operations through managing organizational, financial, medical, and RCM outcomes.

RCMTech , an Inevitable Reality

By utilizing RCM Tech, any healthcare provider adopting a proactive approach to revenue cycle management and continuously improving their processes will be leading in the healthcare sector by elevating the quality of care provided without compromising on sustainable and improved revenue.

About the Author:

Anas Batikhi is the Founder & CEO at Santechture. With an insatiable quest for excellence in solution design and delivery of unrivaled ROI, Anas has spent a considerable part of his career perfecting SANTECHTURE’s suite of products. Formed as a spin-off into a standalone company in 2019, the firm has a proven legacy as a center of excellency in the healthcare RCM Tech domain since its inception in 2009.