Bridge the Gaps between Payer and Provider by Automating Your Revenue Cycle

The health care industry is rapidly evolving. COVID-19 has uncovered a litany of flaws in health care systems, leading to massive changes in the way patients, providers, and payers communicate and operate. One of the highest impact changes in the industry is the widespread shift from a traditional fee-for-service reimbursement system to value-based care. Instead of being incentivized to fill beds, order tests, and perform procedures, care providers are compensated based on patient health outcomes. Innovations in how care is delivered, like the shift to value-based care, are not so simple as a turn of a switch. One process contingent on the success and longevity of provider innovation is their relations with payers.

How payers and providers collaborate to ensure patients receive adequate care is critical to positive outcomes. So, it would seem essential that these two separate, but complementary entities develop a positive, efficient relationship to streamline the claims adjudication process and ultimately provide each other value. This is not the case, though, as the relationship between payer and provider has been historically challenging.

Payers and providers must align administratively, clinically, and economically to mitigate these problems. While this is hard to achieve, it becomes more realistic when communication and visibility are strengthened. On the provider side, deploying an automation-driven revenue cycle management (RCM) strategy will help align the two parties. Antiquated RCM strategies are prone to manual errors and add unnecessary stressors to the payer-provider relationship. By deploying an RCM strategy that leverages intelligent automation, providers and payers can cut down on ambiguities and errors, reducing the odds of claims denials, miscommunication, and lost revenue.