Revenue cycle management, or RCM, is crucial to operating the best medical practice. It impacts the provider’s profits and shapes the patient’s overall experience. To keep pace with the ever-evolving healthcare panorama, providers need a solid grasp of RCM and continuously seek ways to enhance it.
However, most healthcare providers want to know how to Improve Revenue Cycle Management. With tech advancements and shifting patient preferences, many strategies exist to strengthen RCM. Doing so improves both financial stability and patient care quality. Let’s explore further.
Why is RCM Important?
The purpose of RCM is to maximize the provider’s revenue. Effective revenue cycle management keeps medical practices running easily, allowing them to serve greater sufferers. But it is no longer simply the companies who benefit from RCM. With expanded sales, they could allocate extra resources and time to patient care, enhancing the treatment revel in for everyone involved.
Beyond boosting revenue, effective revenue cycle management (RCM) reduces insurance claim denials by ensuring accurate patient information and coding on claims. With fewer denials, providers save on the time and cost of investigating and appealing them, allowing administrative staff to focus more on patient care.
The revenue cycle includes several steps, all vital for timely provider reimbursement. Tasks such as account creation, pre-registration, insurance eligibility verification, and medical coding must be accurate and often take more time. However, speed is equally essential for quick reimbursement, so providers need to make improvements wherever possible. Implementing an automated workflow system can significantly help streamline these processes to Improve Revenue Cycle Management.
Fundamentals of Strong RCM
Getting a single claim paid involves many steps and responsibilities. From submitting multiple claims daily to correcting denials and updating patient information, the revenue cycle management (RCM) process is intricate. To ensure success, billing teams follow several best practices.
The first essential step to Improve Revenue Cycle Management is eligibility verification. Here, providers verify that a patient has active insurance coverage, allowing the company to bill the coverage in preference to asking the patient to pay the entire bill out of pocket. Since most patients can’t afford the money for to pay massive medical bills themselves, having medical health insurance coverage benefits both the provider and the patient.
Next is claims submission. After treatment, the billing team submits a claim to the correct payer, using accurate codes to describe the services provided. With around 10,000 medical billing codes available, billers must choose the right ones to ensure proper claim processing.
If a claim is denied, billers handle denial management by correcting errors and resubmitting the claim for payment.
Though eligibility verification, claims submission, and denial management seem straightforward, various challenges can arise. Providers can further take additional steps to improve their RCM for greater efficiency and success.
How to improve Revenue Cycle Management?
It’s essential to divide the process’s various components to enhance revenue cycle management and concentrate on optimizing each step. From the initial patient encounter to receiving the final payment, every aspect should be carefully considered. Additionally, factors such as staff involvement and billing resources should be noticed.
Understand Payer Rules
Managing payer rules is crucial in the revenue cycle. Medicare, Medicaid, and commercial payers each have specific code usage and claim submission requirements that are subject to frequent changes.
For many billers, staying current with these rules can be challenging, especially in large provider organizations dealing with multiple payers. However, the process becomes much simpler with a claims submission tool that automates rule adherence to Improve Revenue Cycle Management.
Simplify Patient Access
Patient access encompasses the entire process of onboarding new patients. Beyond verifying eligibility, it involves confirming patient details like name, address, and Social Security Number. Providers should also search for additional coverage beyond what the patient provides, as they may have secondary or tertiary coverage they have yet to disclose. Haven’t. This means having multiple payers for claims.
Workflow Automation
Automating workflows is a common strategy to enhance revenue cycle management (RCM). This automation can span various stages, including patient access, claims submission, denial management, and payment collections.
For patient access, deploying a coverage discovery tool can streamline the process by searching for all active payers simultaneously, eliminating the need for separate payer inquiries. Implementing workflow rules such as grouping claims by payer type or assigning them to specific billers can transform a digital stack of claims into a well-organized workload for each staff member during claims submission and denial management.
Leveraging technology to generate templated patient statements and distribute bills via email and standard mail can streamline patient payment collection.
Opportunities for automation abound throughout the revenue cycle. Billing teams must identify areas where technology can have the most significant positive impact on their RCM workflows.
Improve Payment Collections Processes to Improve Revenue Cycle Management
Enhancing payment collection processes is essential for maximizing reimbursement potential. While submitting claims correctly is crucial, patient financial responsibility often constitutes significant revenue. Patients may have co-pays with coverage or lack active coverage altogether, leaving balances to be collected by billing teams.
One practical approach is to provide patients with various payment options. At the very least, offering credit/debit card payment facilities alongside cash or checks is advisable. To improve payment capture rates further, consider implementing payment plans or enabling touchless payment methods like Apple Pay. Some providers even establish patient payment portals, allowing patients to conveniently settle balances online without visiting the office or making phone calls.
Staff Engagement and Training
While technology is valuable, it is vital to apprehend the irreplaceable value of staff members in enhancing revenue cycle management (RCM) techniques. Every team member, whether or not within the front or back office, plays a crucial role, and acknowledging their significance is vital to fostering staff engagement.
To ensure staff are equipped for success, provide comprehensive training for every newly automated workflow. Offer multiple opportunities for training and familiarization with updated processes. Additionally, it offers periodic continued training to reinforce existing processes and foster innovation. Prioritize training for new billers, office administrators, team managers, and anyone involved in the claim lifecycle. Empowering and engaging the team will significantly improve revenue cycle management.
Focus on the Patient’s Experience
In revenue cycle management, prioritizing the patient experience is paramount. Numerous steps in the RCM process can impact this experience positively or negatively.
Longitudinal printed forms can create a poor initial impression during patient access. Instead, new patients can submit their information through an online patient portal before their appointment. This flexibility allows them to provide necessary information at their convenience, saving time during their visit.
When collecting payments, provide various options and consider using branded healthcare statements to simplify understanding of owed amounts. Emphasize educating patients on their coverage and payment responsibilities to prevent billing surprises and foster patient engagement in managing their accounts.
Wrapping Up
In conclusion, Improve Revenue Cycle Management involves a multifaceted approach, encompassing various aspects such as patient access, claims submission, payment collections, and staff engagement. By breaking down the process into manageable components and focusing on efficiency and accuracy at each stage, healthcare providers can maximize revenue potential while enhancing the overall patient experience. Embracing technology for workflow automation, providing comprehensive staff training, and prioritizing patient-centric practices are vital strategies to navigate RCM’s complexities successfully. With a commitment to continuous improvement and a patient-first mindset, organizations can ensure financial stability while delivering high-quality patient care.
