Medical

Covid-19 changed everything for nursing homes. There was a very high fatality rate of senior citizens in nursing homes nationwide, bringing in greater scrutiny of federal regulators on how the industry will operate in the future.  

Nursing homes are seen as the next level of long-term, residential, maintenance care for patients who are otherwise stable but in poor or declining health and unable to fully care for themselves. Elderly and disabled patients are cared for constantly by medical staff working around the clock. Generally speaking, these facilities are supposed to provide a standard of care outlined in the licensing requirements demanded by each state’s department of health and by industry-wide standards. One of these requirements is ‘infection control’. As we’ve been hearing for almost a year, this standard has not been followed by an alarming number across the country, resulting not only in an increased number of infections but also in a disproportionate number of deaths.

Regulatory controls are expected to become considerably stricter, with an increased focus on the provisions of the Nursing Home Transparency and Improvement Act, the Elder Justice Act and the Patient Safety and Abuse Prevention Act, all adopted as part of the ACA.

What are some of the measures nursing homes can take to avoid future disasters?

Hygiene and environmental disinfection

Daily controls through proper hygiene include personal protection, cleaning, disinfection, separating at-risk patients and assigning specific staff members to work on the same patients for an entire week or month, while other patients are cared for by different nurses. In addition, reducing visits in and out of the facility and checking the temperature of staff and residents several times a day are other important control measures. All patients should be kept informed of their condition, treatment and risk factors, and be trained to monitor themselves for any changes. Once personal protection measures are needed, patients and personnel should be shown how to use masks and other devices, and the staff needs to ensure the measures are reinforced daily.

Smart watches

These are relatively inexpensive devices that can monitor not just blood pressure or glucose levels, but also the oxygen saturation in the blood. While some are used by fitness enthusiasts and personal health-minded people, many of them are used by medical professionals and recommended to patients. While a watch cannot provide any cure or help other than a warning, it has been very helpful in detecting early deterioration in blood oxygen levels in people infected with Covid-19.

Some patients who could not be admitted into hospitals were given pulse oximeters to use at home in order to monitor their blood oxygen level. Oximeters give a reading where the O2-saturation levels are shown as a percentage, with anything below 90% being a sign that something could have worsened. While not fool-proof, this method of early detection has been useful for at-risk individuals to know when to contact a doctor or go to the hospital. Providing watches that perform this function to nursing home residents or ensuring they own and wear one all the time may be a valuable strategy financially and medically, particularly if such devices send data over the facility’s wi-fi network for centralized visibility. There might be insurance companies willing to accept a proposal to pay for such devices if it means less medical costs to cover later.

Adoption of AI

AI has transformed from a term favored by sci-fi writers and movie directors to describe a worldwide machine apocalypse in mankind’s future to a technology term that many industries use to denote advanced capabilities of highly-developed computers and software techniques.

In healthcare, hospitals and other stakeholders are increasingly used to the idea of leveraging AI to improve medical care, billing, staff and resource management, and much more. Its predictive capabilities coupled with practical real-time performance, advanced visualizations, and detailed built-in knowledge can offer never-before-seen changes in the healthcare environment.

In nursing homes, AI can be used for speech-driven documentation where nurses and doctors can record their visit in real time. The patient’s file is updated immediately, facilitating communication and decision-making. The search features allow physicians to extract the status of a disease or treatment, dosage schedules, side effects, and more. AI systems for healthcare facilities are HIPAA compliant, requiring authentication and validation for anyone who uses the system.

Some AI solutions are more practical than others, and some are more affordable than others. However, they each undoubtedly improve the logistics of patient care in any healthcare facility with needs that match the features provided by that particular AI system.

Patient portals and social media

Memory and cognitive issues are associated not just with specific various conditions but also with old age itself. For any nursing home employee, being able to communicate clearly, in both directions, with the elderly person under their care is essential. . For that and many reasons, having an IT-proficient employee or an IT specialist by trade among the staff is a necessity, in order to research, propose, install, and use beneficial information technology solutions for the specific needs of a healthcare facility and all its stakeholders.

Creating a patient portal can bridge the gap between the health care staff and the residents, and between the staff, residents and their families. A patient can always access the portal and post items of interest, while the staff and family members can track behavior and detect problems ahead of time, including the patient’s physical condition and their mental state, as well.

Social media is also important because patients can share things as they occur, that they might otherwise forget before the next nurse or doctor visit. The patient can post updates about their progress and about matters of concern, such as recurrent pain or wheezing, depressive states, dizziness.

Care first, Profits secondary

There has been concern about the increased involvement of investment companies in nursing home management and ownership. Private equity firms have been buying nursing homes for years, using them as sources of revenue with little or no concern for the patients residing there.

A New York Times article describes ‘how private investment companies have made it very difficult for plaintiffs to succeed in court and for regulators to levy chainwide fines by creating complex corporate structures that obscure who controls their nursing homes’. In spite of numerous regulatory efforts and lawsuits filed by patients and families of patients, many of these nursing homes don’t rectify their problems and continue getting away with substandard care.

‘More than one-third of deaths in the US are linked to nursing homes’ announced another article from the New York Times, updated in January of 2021. The top 5 nursing homes with the most deaths, whether owned either by private firms or the local authorities, had received numerous warnings and citations over the years for non-compliance and were given abysmal ratings, some of them as low as L or K. The L rating indicates that there’s ‘immediate jeopardy to resident health and safety’ and that the ‘deficiency is widespread’. The letter K stands for ‘immediate jeopardy to resident health and safety’ and that the ‘deficiency is part of a pattern’.

The Covid-19 disaster had been a long time coming, and the management and medical staff of these nursing homes bear the primary responsibility for so many deaths. The public outrage is predicted to last long enough to produce significant changes in compliance laws and oversight by regulatory agencies. As far as the general public is concerned, the reputation of a nursing home will be paramount in determining whether a family selects it as a new home for their beloved relative or not.

Healthcare clinics that wish to succeed in today’s competitive market must strive not only to provide quality care while keeping up with the continual technological advances of such a fast-paced and innovative industry but also to ensure they are managing their costs effectively.

The healthcare market is growing bigger every year – according to the Bureau of Labor Statistics, the number of healthcare clinics opening each year is steadily rising, with healthcare jobs predicted to increase 30 to 40 percent over the next ten years.

When a business implements a cost-optimization plan, there are a few key areas that need careful consideration: cost and pricing evaluation, process and service optimization, and streamlining of system operations. A healthcare clinic is no different, and the principles of lean methodology can be applied to any clinic’s cost optimization plan – adjusting the staff, resources, effort, and energy to guarantee best value for patients.

Optimizing the skills of your staff

Like any business, healthcare clinics will have a wide range of expenses that owners need to cover. From administrative costs to payroll and marketing, the expense categories can vary widely depending on the type of clinic. Here is a general overview of the main areas that can be analyzed in terms of cost-optimization.

For the majority of clinics the bulk of expenses will cover wages and benefits. How can clinics make sure that they are spending wisely here? A clinic’s primary focus should be on efficiency and productivity – ensuring that members of staff are performing to the best of their capabilities so that they can provide the best quality service in the shortest period of time.

Potential time and energy ‘drains’ – distractions, inefficient tools and equipment, poor communication, to name a few – have been known to interfere with staff productivity. To reduce the amount of time spent on unnecessary tasks, a clinic’s work team must be able to take responsibility for the quality of their work as well as learn when to delegate or ask for help.

One of the key area which is often overlooked by managers and owners-operators is instilling into their employees a sense of ownership in the business and its operations. A professional front-desk receptionist, as well as diligent medical assistants, focus on optimizing their own work by taking advantage of the tools at their disposal, their own time-saving micro-planning skills as well as shortcuts provided in the daily workflow.

One of the most valuable assets in a company is an employee who is aware of the costs of their labor to the company and tries to give back as much as they receive. Make sure your managers learn to value the loners or rule-breakers who don’t seem to follow minor policies and procedures but add to the bottom line time and again. They’re some of the biggest contributors to your cost-saving attempts.

Some employees deliver their best work in structured, disciplined environments, while others are just as efficient by organizing themselves to create a more personal, albeit highly efficient environment, which from the outside may seem odd, even rebellious, but that, in the end, is conducive to successful completion of their tasks. Always provide a medium for honest feedback from your employees since they’re often the most qualified to clarify where time and resources are being wasted.

Investing in training could be the key to unlocking your employees’ potential, and studies show that increased responsibility boosts workers’ morale and sense of job satisfaction.

Equipment

As well as training, clinics must be willing to invest in quality equipment. Providing members of staff with the best tools and equipment will allow them to perform their duties efficiently and on-time. As the saying goes, you must spend money to make money. If you do need to spend it, make sure you either invest in long-term solutions which new and veteran employees can use with ease or in good software for one essential aspect of your business, such as accounting or compliance.

When buying clinical equipment, if there’s no extra money in the budget for shiny new machines, make sure that the second-hand options you look at have some warranty. Some second-hand products may be as good as new, while others may be at the end of their lifetime. Make sure you are trained and knowledgeable about the specs you need or that at least one of your employees or partners can provide some guidance.

Marketing

Let’s analyze where money can be saved in the black hole of 21st century business: marketing. The majority of commercial businesses need to allocate large portions of their budget to marketing, but clinics can get by successfully without such spending. A healthcare clinic can tap into a key resource: its referral and client network. Medical colleagues in the same field can refer your business to their clients.

You can also offer incentives to your existing clients to refer you to their friends and family – but remember that for this tactic to work, customer satisfaction through quality service is key. Incentives can take the form of rewards; for example, you can establish a ‘member’s club’ or a points system.
The amount of spending on rent and utilities will vary depending on a clinic’s size and location, but as current real estate trends mean that rental costs get higher and higher each year in urban areas, more businesses are moving toward co-working and shared workspaces. Perhaps, it could even make sense for you to share your space (and therefore, rental costs!) with other healthcare practitioners.

Optimizing platforms, applications, processes and services

An important strategic move for any business looking to manage costs is knowing what services to outsource. If time-consuming tasks could be taken care of externally, then your clinic would have more time and space to focus on providing top-quality care and ensuring customer satisfaction. Could your administrative tasks such as bookkeeping or information technology tasks such as data interpretation, modeling and storage, be outsourced? A cost-benefit analysis is instrumental in determining if it’s better to perform these tasks in-house than to contract someone to do it for you.

Another important area of focus should be ensuring the efficiency of processes: from client registration to scheduling, to appointments and follow up or after-care. What processes are in place and are they efficient? How do you define efficiency?

A clinic’s workflow should aim to be seamless, and healthcare technology can play a vital role here. Do you have a system for online bookings? Can patients schedule their own screenings and appointments through a website or a smartphone application? IT tools and software are constantly improving productivity, and enhancing the quality of care provided. AI (Artificial Intelligence) is making it easier to streamline patient flows, leading to scheduling systems that are more simplified yet efficient than ever before. New software and cloud platform technology have also revolutionized healthcare administration, with everything from billing to medical record filing now being taken care of digitally.

The healthcare sector is receiving more attention in recent times as demand is constantly growing for improved access to quality healthcare. Clinics and healthcare services need to evaluate their spending and make sure they are running as efficiently as they can in order to hold their place in a market that is growing more and more competitive every day. Chances are, there’s at least one area where a business can rethink its budget and expenses but there are also risks whenever cutting expenses starts to affect the quality of patient care and patient acquisition. Being frugal with everything may turn out to be very expensive for your company in the long run.

Doctors are smart people. But even smart people make dumb mistakes sometimes.

Going to medical school doesn’t guarantee that you how to handle your finances. Newly minted physicians earn high incomes but have large amounts of student debt, and generally require specialized insurance. This can get people into trouble if they aren’t aware of best practices for building and holding onto wealth.

Below you’ll find 12 of the most common personal finance mistakes that doctors make. Knowing what can go wrong is the best way to make better decisions.

Ramping Up Spending Too Quickly

Physicians enjoy a large bump in salary when they emerge from their residencies. Many are quick to enjoy the lifestyle this increase affords them. But this ignores the biggest drag on their savings — student debt.

Instead of upgrading your house, car, and lifestyle when you become an attending, you should channel your extra income into paying off your debt, thus establishing a stable financial base. Only then you should start enjoying the spoils of your work.

Not Saving Enough

Even when doctors recognize the value of paying down their debts, they may not save enough for retirement. They often don’t realize the importance of compounding interest and underestimate how much they need to save annually to continue their normal lifestyle into retirement. On average, doctors should be saving at least 20% of their income.

Allocating Assets Inappropriately

Early on in their career, doctors should favor growth investments, like stock funds, REITs, and similar assets. However, safer investments, like government bonds and money market accounts, need to be included as a hedge against loss. High net worth individuals often focus on growth without a safety hedge, which can get them into trouble.

A good rule of thumb is to use your age to set your safe investment percentage. A 30-year-old should have 30% of their portfolio in safe investments. As they age, that percentage goes up, ensuring that a larger share of their assets are protected from loss as they get close to retirement.

Buying Too Much House

Buying a big, expensive house, even if you can afford it, isn’t always the smartest financial move.

That’s because homeownership creates a host of hidden expenses that eat away at a physician’s ability to save. The more expensive the home, the higher these costs climb. Taxes, interest, furnishings, climate control, repairs, and other expenses add up quickly. Be sure that you still have enough income after taking care of these costs to save the recommended 20%.

Not Purchasing Adequate Insurance

Life insurance exists to replace your earning power should you pass away. Doctors can earn quite a bit over their lifetimes. Therefore they need life insurance policies that match. $500,000 worth of coverage seems like a lot, but when you make $200,000 a year, your policy payout won’t last very long.

Doctor’s need at least a million dollars of coverage. Two to three million is better. They also need adequate disability, umbrella, and malpractice insurance. Skimping on any of these could get you into trouble. Similarly having a good dental malpractice insurance policy is important.

Purchasing Insurance They Don’t Need

As important as insurance is, sometimes you don’t need it. Life insurance is the most salient example. It’s intended to support your dependents in the case of your untimely demise, replacing your lifetime earning power.

If you don’t have any dependents, you don’t need life insurance. It’s really that simple.

Playing the Stock Market

The proper way to invest in stocks is to purchase shares in mutual funds. This spreads your risk among hundreds of different companies. However, doctors and other high net worth earners frequently play the market, buying stock in individual companies.

This is a mistake. You’re a doctor, not an investment professional. Even seasoned investors find timing stock picks challenging. The chances that you will pick winners more often than losers are slim. Buying individual stocks is a poor way to build wealth.

Leasing a Car

Doctors don’t drive Hondas, right? They drive expensive status cars. And they want the newest model with all of the bells and whistles. Leases guarantee a new car every few years.

But this is the worst way to buy a car. Leasees are essentially renting their cars on a long term basis. New cars depreciate rapidly within the first few years, causing you to lose significant value on your investment. However, with a lease, you don’t own the car, so you’re not building any value at all.

The better move is to buy a pre-owned luxury car. A vehicle that’s three years old has already depreciated significantly, which means you’ll be getting a discount for an automobile that’s still in excellent condition.

Loaning Money Instead of Giving it Away

It’s nice to have the resources available to help family and friends in need. However, if you want to help, the smart move is to make it a gift instead of a loan. Why?

Because if the person defaults on their loan, it can ruin the relationship. This isn’t a risk when the money is gifted. More importantly, you’re less likely to give away money you can’t afford to live without. You might give someone $1,000, but loan them $10,000 because you’re assuming you’ll be paid back. But what if you aren’t?

Listening to Unqualified Investment Advisors

So you know this guy who knows a woman that’s putting together the “deal of a century.” It’s a “home run,” you’re told. You’ll double your money, guaranteed! You just can’t lose!

When something sounds too good to be true, it usually is. There are no guarantees in investing unless you’re talking about savings accounts and CDs. Make sure you get investment advice only from people qualified to give it.

Not Having a Proper Will

This is a mistake that many people make, but it can be particularly damaging for doctors and other high earners, particularly if you have children. You’re going to accumulate a sizable net worth, and you don’t want to leave its dispersal to chance.

Managing Taxes Inappropriately

There are significant tax shelters available to individuals with high earning power. However, many physicians are unaware of them or are too busy to educate themselves fully. Doctors that don’t manage their tax liabilities properly lose more money to the government than they need to, reducing their overall savings.

It’s best to consult with a trustworthy tax professional to be sure you’re managing your money wisely. And in general, you should find a financial advisor you can trust to look at your entire financial picture.

In our modern, globalized world we are hearing more and more about people traveling outside their country as “medical tourists” for healthcare procedures, treatment, and tests, but why and how does it work? The reasons why a person may travel for treatment vary widely; the patient”s country of origin and destination vary, too. But as the medical tourism market is currently growing rapidly, it is interesting to note that this phenomenon is in fact not quite so new.

We can trace the origin of medical tourism to as far back as Ancient Greece, when pilgrims would travel to the healing temples dedicated to the god of medicine, Asclepius, to be cured of their illnesses. The god”s serpent-entwined staff is still used globally as a symbol for medicine and healthcare today.

After its inception, the United States received more patients than it exported in the medical tourism market. For quite some time America had been one of the pioneers in healthcare technology, bringing the world innovations such as the smallpox vaccine and live-donor organ transplants, and the economy thrived on its reputation as a quality health care provider. A few “hotspots” for medical tourism still exist in the U.S. – mainly for “high-tech” healthcare, for example cancer treatments in Houston and heart surgery in Cleveland. One of the world’s top health care facilities, The Mayo Clinic, markets its services to a global audience, and numerous clinics in Florida and other southern states advertise their care plans in Spanish to attract potential Latin American clients.

But this trend has largely reversed in the past few years, as the U.S. public health care system becomes more and more saturated and the price of private healthcare skyrockets. Many American citizens are looking abroad for quicker and cheaper solutions to their healthcare needs. Other factors, such as ease of access to information through the internet and the lower costs of air travel, have meant that it is easier than ever to seek treatments abroad.

For American medical tourists, economic statistics point to both Canada and South America as the main destinations – the ease of shorter cross-border travel being a motivator, as well as, for some citizens, the opportunity to return to their country of origin where they have family or friends to accompany them.

Other global statistics show that many economies across Asia are being boosted by the new medical tourism market, notably China, India and Singapore. For instance, India advertises treatments of the same quality and care with the same results as the U.S. but for a fifth of the cost. Medical tourism is on the rise, in spite of concerns regarding the quality of care, legality of procedures and treatments, language barriers that make diagnoses and consent forms difficult to understand and despite the issues of continuity of care, and post-operatory travel.

Research dating from 2017 from the Organisation for Economic Co-operation and Development (OECD) pointed out that Americans pay more out-of-pocket for health care than any other high-income country and an average of 1.4 million Americans travel abroad for healthcare per year, almost twice as many as in 2007. Many of them are patients who can”t afford insurance or patients who are not fully covered by their insurance plans. Others are simply frustrated by high costs and the lack of cost transparency in the U.S., the stress of having to deal with insurance companies and repeated rejections of insurance claims, administrative sinkholes, seeing too many overspecialized doctors, or feeling over-treated by inattentive, indifferent providers.

The negative impact on the U.S. medical system ranges from being perceived as predatory and discriminatory towards the poor to losing revenue to other countries. On the other hand, medical tourism has become a niche industry on its own which facilitates treatment abroad but charges for it here, in the US. Some of that revenue re-enters the American economy. Health care reforms, such as the Affordable Care Act, extended health care to 30 million Americans who could have otherwise become medical tourists in other countries. At that time there were concerns in the medical tourism industry that the slump those facilitators had experienced after the 2008 recession would continue. As mentioned in the report from OECD about the increase of medical tourists between 2007-2017, that was not the case.

Both industries, the medical industry proper and medical tourism have adapted not only to the fluctuations in demand and prices, but also to the logistics of providing care to patients who want to take advantage of medical vacations abroad, whether they come into the U.S. or travel outside the U.S. For example, Massachusetts General Hospital has a dedicated International Patient Center in an effort to attract foreign patients who are willing to pay high prices for top care and state-of-the-art facilities. Websites like http://www.mymedholiday.com/ offer international treatment options as well as local.

Other hospitals and clinics in the U.S. have jumped on the bandwagon by aggressively advertising to foreign patients from Asia, South America, and even Canada. U.S. insurance companies have been expanding medical insurance to global travelers. The old fear that medical tourism would unbalance the national health care system and would worsen disparities between services made available to humble citizens versus cash-wielding foreigners has been put to bed by the health care professionals” ability to adapt, and the increased availability of health care services for all budgets.

Some benefits we may see emerge from the medical tourism industry could be economies in developing nations thrive from the new source of income that creates jobs, not just the medical field”s clinics, laboratories and technology start-ups but also in the tourism sector. Another positive impact could be the increased competition in the healthcare industry leading to overall global improvements and advances in healthcare technology, procedures and infrastructure as well as after-care facilities and treatments.

The medical tourism market is predicted to expand rapidly by 2027 at a compound annual growth rate of 21.1%, so it”s no wonder many countries want to see their economies benefit, and the goal is to attract, attract, attract. Competing offers in healthcare may see an overall increase in standards of care as each provider seeks to outdo its competitor to get the best reviews and ratings. A global movement of evaluation and standardization of medical protocols is underway, taking the shape of accreditation programs such as the Global Healthcare Accreditation (GHA) program.

Whatever the next few years will bring on the global health front, it looks like medical tourism will continue to have a significant impact around the globe.

In many ways, it doesn’t matter how knowledgable a doctor is, or how much they care for their patients if the patients aren’t actively engaged in their care. That’s because unless they’re willing to follow their doctor’s advice and do what it takes to stay healthy, the quality of service means nothing.

That’s why, in a patient-centered care model, patient engagement is critical. Engaged patients drive better outcomes for themselves, reduce operating costs, and improve the relationship between themselves and their caregivers.

However, improving engagement isn’t always easy. Clients can be resistant to their diagnoses, their care regimens, and the costs associated with their treatments. Overcoming these obstacles is a primary concern for patient-centered organizations. The strategies detailed below represent best practices for getting patients past the blocks preventing them from engaging deeply with their healthcare.

Collaborate With Patients on Their Healthcare Goals

Patients are far more likely to feel vested in their healthcare outcomes when they’re given a voice in their care. Instead of a physician dictating a regimen that’s divorced from the realities of the patient’s life, it’s more effective to treat care as a conversation.

For example, a patient suffering from high blood pressure might decide that their healthcare goal is to stop being dependant on medication. When they come to this decision on their own, they’re more likely to develop the healthy habits necessary to achieve their goal.

Encourage Questions and Explain Things Thoroughly

Patients with a comprehensive understanding of their condition, what it means for them, and the purpose of their treatments will engage more deeply simply because they feel like active participants. Instead of receiving treatment edicts from their doctor’s ivory tower, they feel like partners in their care.

Therefore, it’s in a patient’s best interest for doctors to treat all questions with respect, and to answer them a patiently and as thoroughly as possible. This often means reducing complex concepts to explanations simple enough for a child to understand. Doctor’s shouldn’t assume their patients have the requisite knowledge base to grasp the ramifications of their health issues fully. They should listen first and then explain.

Take Advantage of Engagement Technologies

Several technologies can be utilized to increase engagement. Patient portals make it easy for them to ask questions, access previous conversations, request refills, make payments, and more. Portals increase engagement by allowing real-time access to care options in unprecedented ways.

Telehealth technologies do the same thing for patient appointments. When they need to see their doctor, patients are more likely to act when they know a video chat is all that’s required. It’s faster for them, and the caregiver, which makes it more likely the patient will seek the care they need.

An underappreciated technology that’s quite effective at improving outcomes is an appointment reminder system. Simply reminding people of upcoming doctor visits dramatically increases attendance.

Create Patient Accountability

People are more likely to do what they’re supposed to when they know they’re going to be held to account for their actions. Gym buddies are an example of the sort of accountability that health practices should strive for. You’ll show up to the gym even if you don’t want to because you know you’ll have to explain yourself if your buddy shows up and you’re not there.

Once a patient chooses a goal, doctors should set up some means to ensure accountability. That might mean weekly check-ins. Support groups can also be an effective way of creating accountability.

However this accountability is accomplished, it’s critical that patients feel there are tangible consequences for not doing what’s required of them, consequences beyond their health.

Cultivate a Focus on Preventative Care

Illness can have a profound affect on a patient’s mental state. Depression and resignation can make it difficult for people to engage actively in improving their situation. That’s why preventative care is so critical. It helps keep people healthy so that they aren’t faced with major treatment issues.

Preventative care is an engaging practice because it’s proactive. It’s not a reaction to something external to the patient. It’s a conscious choice the patient makes. It means actively engaging in their health outcomes because they want to, not because an illness is forcing them to. Preventative care creates good habits that can then carry over if an illness does appear.

Patient-centered care is also a choice, one that hospitals and medical offices need to make every day. The suggestions offered here can help practices drive better outcomes for themselves and their patients.

Revenue cycle management in healthcare is a critical discipline. It keeps the lights on and maintains a practice’s ability to see patients. Without it, efficient data collection and patient billing aren’t possible. And with healthcare complexity increasing year upon year, the hunt for qualified individuals assumes a higher priority.

Certified revenue cycle representatives (CRCRs) are revenue professionals with specialized credentials that ensure they have the knowledge, skills, and attitude needed for success in modern healthcare. CRCRs demonstrate their readiness by passing an exam administered by the Healthcare Financial Management Association.

Acquiring CRCR certification can be a wise career move for anyone in healthcare revenue cycle management that wants to extend their skills, increase their marketability, and scale their earning potential.

What Are the Responsibilities of a Certified Revenue Cycle Representative?

A CRCR handles a patient’s financial journey through the healthcare system — from the moment they request an appointment until the very last claim and payment has been handled. Representatives are tasked with shepherding this process to avoid the many pitfalls that can cause problems for the practice and their patients.

New patients come to a medical provider with a raft of information that must be carefully collected and notated. Mistakes at this stage can lead to insurance denials and other problems down the road. CRCR’s have the training required to handle even complicated pre-registrations.

Representatives must also be skilled with claims submissions and understand the nuances involved with accurately coding medical services. Improperly-coded submissions may lead to financial losses and service denials.

Once claims are in process, there are plenty of back-office responsibilities required for proper stewardship of patient accounts, including payment posting, statement processing, collections, and handling claims denials. At each point, mistakes can cause delays, missed payments, and angry patients.

Ultimately, it’s the CRCR’s responsibility to maintain efficient procedures and systems that ensure insurance companies and patients appropriately compensate the healthcare provider, and that these fees are collected as quickly as possible.

What You Can Expect From the CRCR Exam

Candidates can prepare for their exam with online materials provided by HFMA. Members get access for free. A $399 fee is required for the study materials and the exam if you don’t join the organization.

To earn their certification, candidates must complete the full program and then score at least 70% of the questions right on their exam. They’ll have 90 minutes to complete the test. If they fail on their first attempt, they’re required to wait 30 days before making another attempt. Once awarded, certifications last for two years. Recertification is required every two years, earned by passing a recertification exam.

The test is 75 questions long and focuses on several broad topic categories, including:

• Ethical practices
• Compliance regulations
• Patient-centric revenue cycle best practices
• Revenue cycle KPMs
• Best practices for patient financial communications
• Payment models
• Patient satisfaction management
• Claims requirements
• Patient estimates and price transparency
• Financial assistance requirements

According to HFMA’s official course description, after completing your certification you’ll be prepared to:

“Identify processes and techniques for both enhancing the patient experience and improving financial performance, explore the most effective ways to reduce denials and simplify collections, review regulations to assure compliance, outline effective ways to increase interdepartmental cooperation, heighten staff confidence and improve work satisfaction, and create effective ways to measure revenue cycle staff proficiency, recognize staff knowledge and expertise, and decrease turnover.”

Like any other certification, the CRCR provides its recipients an edge over the competition. They become more attractive to employers because their certification provides tangible proof that they have the skills medical offices are looking for. Once on the job, they’re more effective due to the specialized skills the CRCR training provides.

Holding a CRCR certification offers revenue professionals a more nuanced perspective on their industry. They’re better equipped to keep current with the inevitable shifts in practices and procedures that occur as healthcare evolves. And because they’re required to recertify every two years, their knowledge is guaranteed to be up to date.

Healthcare revenue workers looking to cement their place in the industry would do well to become a certified revenue cycle representative. It’s good for them and it’s good for healthcare generally.