Revenue cycle management is critical for running a profitable medical practice. Firstly, it directly impacts the service provider’s bottom line. Moreover, healthcare revenue cycle solutions directly affect the patient and their experience.
Hence, providers should thoroughly understand revenue cycle management and always seek methods to improve their RCM and stay up with the ever-evolving changes and trends in the healthcare business.
So, how can a business enhance its revenue cycle management?
Numerous opportunities exist for providers to enhance their RCM strategies in light of emerging technologies and shifting patient preferences, which can positively impact both financial stability and the quality of care they can offer. Let us learn more.
Why Is Revenue Cycle Management Important?
Firstly, revenue cycle management boosts healthcare provider revenue. It helps healthcare providers stay open and treat more patients. Moreover, it increases income and reduces insurance claim denials by verifying patient data and coding. Claim denials before appeals save providers time and money. Thus, administrative staff will have more time for clients.
The revenue cycle determines provider reimbursement speed. Account setup, pre-registration, insurance eligibility verification, and medical coding require precision and take longer. Getting reimbursed for these errands requires speed. Hence, workflow automation is useful.
Here Are 4 Ways Practices Can Improve Healthcare Revenue Cycle Management:
1. Automating Manually Performed Tasks
Patient appointment reminders and scheduling automation: Your front desk’s efforts in patient communication could greatly benefit from an automated method. Patients can search for available appointments and enter their information on a centralized website. No longer will your patients or employees need to manually fill out lengthy paper forms, which are prone to human mistakes.
No longer will claims be denied because of typos in insurance numbers or incorrect dates of service. In addition to saving time and effort, automated patient reminders can be created to get patients to the clinic on the appointed day and time. Appointment changes and subsequent visits can be better coordinated with this system.
Card on file technique: Among the best practices in revenue cycle management, “card on file” refers to saving a patient’s credit card details in their electronic medical record. After insurance has paid their portion, the patient can be given the option of utilizing this card to settle any remaining balance. This means that follow-up office visits from patients just to collect money are no longer necessary.
Cloud-based data management system: Using a sophisticated cloud-based documentation system, you can easily access and integrate your business’s front- and back-end processes. The information you provide is traceable and can be altered to fit other files, like invoices and claims in the revenue cycle. This saves time and effort because you won’t have to enter the same information into multiple documents.
Automatic claim generators: Implementing billing software makes processing claims simpler than before. It can produce electronic claims based on diagnostic and treatment code analysis. With more and more insurance providers accepting electronic claims, it is prudent to have claim generator software structured to the specific needs of the payor.
2. Improved Medical Transcription and Coding Practices
The most fundamental requirement for validating claims regarding care received is error-free, comprehensive electronic health records. The transcribing process should capture every nuance of the patient visit, including dates, names, authorizations, and specifics.
Experts should also handle the coding process, as they will be able to examine the files and reliably extract all instances that can be coded. If the charge collection procedure is messed up due to an erroneous code, missing code, or insufficient data, you will not be paid for the valuable service you gave.
Staff training on compliance: Constant legislation changes from the state and insurance companies make it difficult to operate within the law. Keeping your team trained and up-to-date on the most recent coding techniques is essential to any revenue cycle management action plan.
Coding and billing audit: Auditing your facility’s coding and billing practices regularly might help you better manage your healthcare organization’s revenue cycle. You can either assemble an internal auditing team to make this or contract with an outside firm. Examine your billing schedules, policies, and procedures for inconsistencies and revenue leaks. This aids in the early detection of fraud, HIPAA violations, or coding errors, allowing you to avoid legal trouble.
3. Tracking of Claims and Denial Management
Your efforts to improve the revenue cycle should center on getting paid by insurance companies more quickly. The necessity of producing “clean claims” for better healthcare revenue cycle management cannot be overstated. Follow these steps to produce “clean claims:”
Clean scrubbing claims before submission: To check for mistakes that could result in a denial, the claim should be sent to a clearinghouse, or clean scrubbing software should be used. There is inconsistency in the information provided, and it must be cleaned up throughout all patient, provider, insurer, and coding records. As a means of bettering healthcare revenue cycle management, this method verifies that the information in your medical records supports your payment request and assists you in submitting a claim that is both complete and error-free.
Denial management and appeal process: The insurance company may still reject or deny your claim even though you’ve taken every precaution to ensure they pay you, so you’ll need a system to handle denials and appeals. Follow the progression of your claim filing and be ready to appeal and resubmit claims if necessary. Speed in converting denied claims into claims deserving of approval is paramount for your accounts receivable.
4. Outsourcing RCM Services to Improve Healthcare Revenue Cycle Management
This is the best revenue cycle efficiency method. Delegating administrative work to specialists lets you focus on patient care instead of management.
Outsourcing management companies can assist with pre-authorizations, clinical recording, coding, bill collection, claim creation, and rejection handling. It’s like having an in-house compliance manager to solve data capture issues. Lastly, employing experienced specialists, cutting-edge tech, and other resources increases profits.
Maintaining a financially sound revenue cycle is essential to the success of any business and can be accomplished by implementing efficient strategies for optimizing revenue cycle management.
It is crucial to provide patients with clear information, accept online payments, automate administrative processes, and properly train staff. You can avoid frustration and better use your team’s valuable time by outsourcing to a dependable partner.