Health systems across the country are losing millions of dollars annually due to revenue cycle inefficiencies, staffing shortages and inadequate billing practices. While they have historically been well-positioned to provide home infusion services, many are struggling to capture the revenue they deserve.
The good news? There is a path forward. By optimizing revenue cycle management (RCM), leveraging purpose-built technology and considering outsourcing, health systems can regain financial stability while improving patient care.
Why Every Health System Should Be in Infusion
Health systems are natural leaders in infusion therapy due to their strengths in operations and patient care. They bring several advantages to the table:
- Operational Excellence – They excel at managing clinical workflows, making them well-suited for infusion services.
- Strong Referral Networks – A built-in ecosystem of referring physicians ensures a steady stream of patients.
- Continuum of Care – Infusion therapy seamlessly extends patient care from acute settings to post-acute and home-based care.
- Accreditations & Compliance – Many already meet stringent accreditation requirements.
- Proven Success – They have demonstrated their ability to deliver high-quality home infusion services.
Yet, despite these advantages, health systems continue to face significant financial losses in their infusion programs. Why?
1. Using Internal RCM for Infusion Billing – A Costly Mistake
Countless mistakenly rely on their internal RCM teams to handle infusion billing. While this may seem like a logical approach, infusion therapy billing presents unique challenges that internal teams are not necessarily equipped to manage. Unlike traditional billing practices, home and specialty infusion require a deep understanding of complex medication pricing, payer policies and regulatory compliance.
One of the primary challenges is the high specialization and complexity of infusion therapy. Every medication has unique billing and reimbursement requirements, making it difficult for general health system billing teams to manage claims accurately. Additionally, regulatory compliance plays a crucial role in infusion RCM, as Medicare and accreditation guidelines mandate precise documentation and coding to ensure proper reimbursement.
Another layer of complexity comes from the administrative time of medication—billing must accurately reflect not only the cost of the drug but also the time spent on administration – a factor that differs significantly from health system billing. Furthermore, diverse billing codes and payer policies create additional hurdles. Unlike inpatient and outpatient health system billing, home infusion lacks standardization, leading to increased claim denials and payment delays.
Without a dedicated infusion RCM team, health systems risk increased denials, revenue loss and operational inefficiencies. Health systems need to recognize that infusion billing is a specialized process that requires the right expertise and technology to optimize reimbursement and cash flow.
2. Using Internal EMRs or Multiple Systems for Infusion Billing
Another common mistake is attempting to bill infusion services through the health system’s electronic medical record (EMR) system or managing multiple disconnected billing platforms. While a health system’s own EMRs can be effective for inpatient billing, they are not designed to handle the unique nuances of infusion revenue cycle management. Similarly, using multiple systems leads to inefficiencies, errors and revenue loss.
When infusion billing operates across disjointed systems, data fragmentation becomes a major issue. Patient and referral data are often stored in separate platforms, making it difficult to track claims, identify billing discrepancies and manage the revenue cycle efficiently. This lack of integration leads to errors and omissions, which increase the likelihood of claim denials and reimbursement delays.
Additionally, managing multiple systems results in inefficiency and redundancy, as billing staff must manually reconcile information, leading to increased administrative burdens and operational slowdowns. These inefficiencies also create compliance risks, as regulatory requirements become more complex when multiple platforms are involved, increasing the likelihood of audits and penalties.
Another major drawback is the lack of analytics and reporting capabilities. Without clear visibility into key performance indicators (KPIs) and revenue cycle trends, it’s possible to struggle to make informed financial decisions.
3. Understaffing – Secretly Impacting the Bottom Line
Many health systems are critically understaffed and may not even realize the extent of the issue. Since the COVID-19 pandemic, employment has declined while labor costs have surged. This staffing shortage directly impacts revenue cycle performance, leading to billing errors, delayed reimbursements and disruptions in patient care.
When RCM teams are overwhelmed, claim submission accuracy suffers, resulting in a higher percentage of denials and rework. Additionally, lengthy reimbursement cycles create cash flow challenges, making it difficult for systems to sustain their infusion programs. The increased workload on a limited staff also raises the risk of compliance violations, as overworked billing teams may struggle to keep up with evolving payer regulations.
Next Steps: How to Rethink RCM Success
To combat revenue cycle challenges, leading health systems are rethinking their RCM strategies. More than 30 health systems have already partnered with Prochant to implement technology-driven solutions and specialized expertise that enhance revenue cycle performance. By taking a proactive approach, health systems can:
- Reduce write-offs and prevent revenue leakage with expert claims management.
- Improve billing accuracy and compliance by leveraging dedicated infusion billing specialists.
- Enhance operational efficiency through real-time analytics that identify revenue trends and performance gaps.
- Scale infusion services without increasing administrative burden, thanks to intelligent workflow automation.
How Prochant Helps:
- Prochant Pulse Analytics delivers real-time revenue insights, allowing health systems to monitor performance and address issues proactively.
- Seamless integration with most major billing systems eliminates data fragmentation and reduces billing errors.
- Pulse Connect optimizes workflow allocation, ensuring claims are processed accurately and efficiently.
- Outsourcing RCM alleviates the burden of hiring, training and retaining in-house staff, enabling health systems to scale effectively.
- Dedicated RCM experts focus solely on infusion billing, reducing denials and accelerating revenue collection.
Ready to Take Control of Your Revenue Cycle?
Let’s discuss how we can help you offset revenue loss and build a sustainable home infusion program.
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