Health Information Systems

The revenue cycle is the central nervous system of any healthcare enterprise. It communicates and coordinates information about the system’s most important relationship with Patients, Providers, and Payers. An integrated revenue cycle will help healthcare systems strengthen these relationships. MetahOS Helps Reduce Accounts Receivables for Hospitals. 

What Are Accounts Receivables (A/R)?

Accounts Receivables are simply money that has already been earned but not received by hospitals when a hospital bills its insurance companies (payers) for treating their subscribing patients, resulting in outstanding payments owed to the hospital by the payers.

Who are these Payers?

These Payers typically are:

• Private Insurance Companies: Bajaj Allianz and any other Health Insurance Companies
• Corporates & MSMEs: Industries, Railways which contract a hospital to provide care to their employees
• Government Schemes: Employee State Insurance (ESI), ECHS, Ayushman Bharat, Arogya Bhagya, and countless other state and central government schemes.

Understanding Your A/R Report

A hospital’s Accounts Receivables report lists all inpatient and outpatient services rendered to patients during a given period. These reports are used to determine how much a patient owes the hospital for services and/or supplies. 

A mid-size hospital’s A/R is typically 1-year of EBIDTA, and, in some cases, it might go up to 2-years of EBIDTA.

Root Cause Analysis: Why Does A/R Increase?

An increase in Accounts Receivables starts when the patient is admitted and multiplies each day for every mistake across the patient journey. Most often, the delay in Receivables is due to lapses at the Hospital end.

Below are the 6 common root causes of delay in A/R

1. Patient Admission/Registration

   1. Unavailability of Patient Checklist for Eligibility
   2. Efficient Screening Process
   3. Staff Training Issues

2. Ward

   1. Delay in Updation of Records
   2. Incomplete File

3. Reports

   1. Delay in Radiology Reports
   2. Delay in Lab Reports

4. Billing

   1. Random Selection of File for Bill Processing
   2. Delay in Investigations Report

5. Government & Validation Desk

   1. Unavailability of Patient-Centered Counselling
   2. No Requirement to Enter a Discharge Summary

6. Claims

   1. Absence of Process Monitoring
   2. Shortage of Man Power

How to Overcome These Pitfalls

Hospitals need to bring in change through the following 6 drivers.

1. Revenue Realization

   • Improve revenue growth by decreasing A/R

2. Increased Productivity

   • Decrease time taken to submit claims by at least 50%

3. Service Delivery Improvement

   • Measures to improve the flow of documents between departments

4. Cost Reduction

   • Reduce cost by enabling single entry, multi-use

5. Treatment of Operational Risk

   • Reduce PEOPLE dependency; increase PROCESS dependency

6. Compliance

   • Stay compliant while improving processes, training, and enabling technology

Risk Awareness and How to Mitigate

Knowing your risks is half battle won! As Sun Zhu, the author of Art of War, says, “If you know the enemy and know yourself, you need not fear the result of a hundred battles. If you know yourself but not the enemy, for every victory gained, you will also suffer a defeat. If you know neither the enemy nor yourself, you will succumb in every battle.“

Some of the common risks include:

1. Systems are not interoperable nor integrated, thereby creating duplicate transactions on multiple systems.
2. Too much dependency on Human Resources rather than processes.
3. Unaware of daily vital statistics to the running of a hospital.

Recommendations for Operational and Financial Gains

Identify Bottlenecks and Fix

Like a supply line in a manufacturing company, the files move in a predefined order. Still, every process creates bottlenecks if the implementor does not understand the Theory of Constraints.

Baseline Performance Profile

For consistent data to assess action areas, proceed with data collections, and Revenue Cycle improvement.

IT Optimization

An ongoing process that uses best practices and solutions to remove gaps. Also, initiate Continuous Improvement Process (CIP) and award best practices.

Patient-Centric Revenue Cycle

A Patient-Centric Healthcare System would improve care delivery and provide seamless integration across scheduling, registration, arrival, care delivery, billing, post-care, collections, and be key for revenue integrity & market leadership.

Hospitals can now benefit quickly from MetahOS Integrated Receivables Management System (IRMS), as it can work alongside any Health Information System (HIS). Along with IRMS, you also get

1. End-to-end transformation

   Deliver comprehensive revenue cycle services, including process redesign, technology enhancement, organizational design, and performance management.

2. Revenue cycle business intelligence

   Conduct root cause analysis of revenue leakage to identify net revenue, reduce bad debt, and accelerate collections.

3. Charge integrity and reimbursement

   Drive net revenue improvement through an enhanced mid-cycle process.

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4. Revenue cycle systems implementation

   Plan, design, and implement technology systems.

5. Revenue cycle tools

   Automate workflow processes and enhance reporting capabilities through IRMS.

Currently, 80% of all Hospitals are not utilizing the power of the Integrated Receivables Management System.
The lack of integrated tools leaves hospitals frustrated with not getting paid on time and with no time to handle their receivables. This is where MetahOS Helps Your Hospitals Reduce Accounts Receivables.