For many providers, one of the most crucial business operations is revenue cycle management, or RCM. For tiny practices, it’s what “keeps the lights on,” and for huge health systems, it helps preserve healthy operating margins. However, revenue cycle management procedures must be straightforward and effective from beginning to end, regardless of how many claims a billing team submits. Gaining an understanding of how to enhance revenue cycle management needs to be a consistent goal. In addition to compromising the patient experience and maybe causing staff burnout, providers might be wasting money otherwise.
Basics of strong revenue cycle management
Getting a single claim to the appropriate payer and paid in full involves a lot of roles and duties, let alone filing several claims daily, resolving denials, locating more active coverage, and gathering new patient data. Although revenue cycle management is a complicated process, all billing teams follow a few best practices to guarantee success. Verification of eligibility is an important initial step. When a provider verifies that a patient has active coverage, they can bill the patient’s health insurance instead of requesting full payment. Patients typically lack the funds to pay their costs in full out of pocket, but health insurance does, so this is perfect for the provider.
Submission of claims follows. The billing team is in charge of sending a claim to the appropriate payer with all the necessary codes to specify the type of therapy that was provided once the patient has received it. With over 10,000 medical billing codes to select from, billers have a difficult task in making sure they always use the correct codes. If a claim is rejected, billers have the option to revise it to fix errors and submit it again for reimbursement. Denial management is the term used to describe this. Despite how simple eligibility verification, claims filing, and denial management may seem, there are many potential problems that may arise, as well as extra actions that providers can take to increase the performance of their revenue cycle management.
How to improve revenue cycle management?
Dividing the process into several parts and concentrating on making each one as effective as possible is the greatest approach to enhance revenue cycle management. From the initial patient encounter to the last payment, take into account every detail. Don’t forget to account for staff involvement and billing resources.
Make patient access easier
The complete new patient procedure is known as patient access. Eligibility verification is one of the steps, as was previously indicated, but it is not the only one. Verifying patient demographics, including first and last name, current address, and Social Security number, is another aspect of patient access. For verification, it’s also best for providers to look for any additional coverage beyond what the patient has supplied.
Patients frequently have secondary or even tertiary coverage that they have not declared or are not aware of. You can submit claims to a second and a third prospective payer!
The finest aspect? Front-of-house teams don’t need to take on more work as a result of this. The proper software makes it simple to manage every aspect of patient access, including storing patient data, confirming coverage and demographics, and preventing potential revenue cycle errors later on.
Recognize the payer regulations
Let’s talk about payer regulations about any errors in the revenue cycle. Commercial payers, Medicare, and Medicaid all have their guidelines about which codes to use and how to file claims. And those guidelines are subject to change at any time.
It is considerably simpler to make sure that every claim is delivered to the appropriate payer and complies with the most recent regulations for individuals who have access to a claims submission tool that determines payer rules on their behalf. This is done for you via Inovalon’s revenue cycle management software. Our in-app instructions are updated to reflect the most recent changes due to our payer relationships, assuring users that their claims are always prepared in compliance with each payer’s regulations.
Workflow automation
Increasing revenue cycle management is also frequently achieved through workflow automation. This can happen when a patient is assessed, when a claim is submitted and denied, when money is collected, and more. Use a coverage discovery tool that can look for all active payers simultaneously and eliminate the need for separate payer inquiries to automate patient access.
Workflow rules, such as classifying claims by payer type or assigning them to a particular biller, can transform a digital “pile” of thousands of claims into a structured collection of claims that each individual can concentrate on during the submission and rejection management processes. Allow technology to handle the creation of templated patient statements and the email and regular mail delivery of invoices to facilitate patient payment collections.
What are the common challenges of revenue cycle management in healthcare?
Despite its great usefulness, technology cannot completely replace the importance of employees. Every employee in the front and back offices has a vital role to play in enhancing RCM procedures, and they must be aware of this. Clarifying each person’s worth and providing them with the resources they require to thrive are the first steps in fostering staff engagement. Provide numerous opportunities for training and familiarization with the modified procedures for each newly automated workflow. Provide recurring ongoing training to support the reinforcement of established procedures; these engagements also present excellent chances for additional innovation. Additionally, for team managers, office administrators, new billers, and anybody else involved in the claim lifecycle, make training the top priority.
1. Keep an eye on your revenue cycle
It is more important to determine which aspect of the revenue cycle should be prioritized than to completely restructure your RCM workflow to optimize revenue cycle management. The fundamentals of RCM will never change: confirm patient details and eligibility, prepare a claim using the proper codes, and submit the claim to the relevant payer. Nonetheless, those phases offer several chances to create streamlined, more effective procedures that prioritize the patient experience. In order to improve revenue cycle management effectiveness, it is worthwhile to invest in technologies that can combine several claims and files into one location, automate workflows, and provide more resources and training for employees.
2. Interoperability issues and technological constraints
The RCM solution software is often isolated from other essential operations, such as patient engagement tools and electronic health records, in healthcare businesses. This lack of integration often reduces process efficiency and may increase the likelihood of errors. To lessen these difficulties, practices should search for an integrated, interoperable platform.
Why is it important to optimize your healthcare revenue cycle?
With almost 62% of doctors in the US worrying about their practice’s financial viability, optimized revenue cycle management is more important than ever. Let’s examine some of the advantages of a properly managed revenue cycle in more detail.
- Better cash flow and revenue generation: Healthcare businesses see better cash flow as a result of efficient RCM procedures that maximize payment collection. Organizations can improve their financial management and fulfill their financial commitments by decreasing claim denials, cutting down on payment delays, and improving payment accuracy.
- Decreased claim rejections and denials: One of the main advantages of revenue cycle management is that it reduces the number of claims that are denied or rejected.
Furthermore, join Oxford Training Centre’s expert-led Healthcare Management training courses to master effective healthcare operations, risk management, and innovation, empowering you to lead confidently in today’s evolving healthcare landscape.