Hollywood math and the reluctant heroes of the revenue cycle
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Inovalon
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We’ve enjoyed being part of the HFMA experience and having insightful discussions about innovative solutions for many years. Last year for example, an Inovalon sales executive sat down with the HFMA team to discuss “Hollywood Math and the Reluctant Heroes of the Revenue Cycle.”
Here’s a recap of his conversation.
Lights, camera, revenue cycle!
When discussing Hollywood math, we refer to how movies capture our attention and leave a lasting impression. Think about the greatest movie you’ve ever seen. What makes it memorable? Perhaps it’s the captivating storyline, the intense action sequences, or the remarkable characters. One classic example is the movie “Jaws.”
Even after all these years, we remember the suspense and fear created by the iconic shark.
But what does this have to do with the revenue cycle? Just as Hollywood movies engage us with compelling narratives and reluctant heroes, our revenue cycle challenges can be complex and suspenseful.
There was a lot of discussion at HFMA about collaboration between physicians and billing and coding staff. Other topics included the power of AI and when to involve a human touch to enhance the patient experience. This idea aligns with the audience engagement tactics from a successful Hollywood script.
Mounting healthcare revenue cycle challenges
Today, hospitals still operate below pre-pandemic margins, which were slim initially. Since the pandemic, administrative costs constitute as much as 31% of total health care spending — 82% of which can be attributed to billing and insurance, 65% of claims are never resubmitted, 56% of patients delay paying bills because it’s too complex, and the staff that carries the knowledge to use Direct Data Entry (DDE) or understands the nuances of various payer rules are leaving the organization.
Additionally, with the Medicare population expected to increase to more than 80 million beneficiaries in 2030, healthcare providers face more intricate reimbursement requirements. The staff with expertise in navigating payer rules is also dwindling, creating further obstacles.
In his interview, our sales executive exclaimed that as partners to healthcare providers, Inovalon is responsible for being the “Robin” to their “Batman.” They must help identify, understand, and proactively address potential issues in the revenue cycle.
How Inovalon helps
Inovalon provides cloud-based solutions to address the administrative complexities of healthcare. What sets Inovalon apart is its revenue cycle workflows and customer service.
Enhanced workflows
By tackling Medicare’s most challenging claim management processes, Inovalon has become an expert in the field. As the nation’s first and largest network service vendor, Inovalon builds integrated workflows integrated workflows that support all key revenue cycle management (RCM) steps, offering time-saving advantages to healthcare organizations nationwide.
By applying logic and rules, the processes for filing Medicare, Medicaid, or commercial claims become relatively similar, further streamlining operations.
Customer service
Inovalon’s commitment to customer success is exemplified through its responsive service team. Working closely with customers, they help troubleshoot issues, identify custom business rule requirements, and ensure smooth operations. They aim to empower providers and optimize the revenue cycle.
By automating and streamlining RCM workflows, providers can improve efficiency, accuracy, and financial outcomes. Inovalon’s commitment to customer service ensures that healthcare organizations receive the support they need to succeed as the world changes.
Contact us today to learn more about Inovalon and our revenue cycle management solutions.
Source:
1. “The Financial Stability of America’s Hospitals and Health Systems Is at Risk as the Costs of Caring Continue to Rise,” AHA, April 2023, https://www.aha.org/costsofcaring
2. “3 Things Every Baby Boomer Should Know Before Age 65,” RetireMed, accessed June 23, 2023, https://www.retiremed.com/library/blog/3-things-every-baby-boomer-should-know-age-65
