The revenue cycle for a healthcare provider begins with the patient scheduling their appointment and ends when the payment for the services taken is cleared, by either the provider or the payor. In the interim period, many steps need to be completed accurately to avoid any delays in payment, which can hold back your practice financially. Coding errors, inefficient claim denial management, or data duplication are just a few examples of inefficiencies in your RCM. Efficient RCM can provide financial stability and improve profitability for your healthcare business. That said, many practices still need help to optimize their back-end operations and to keep their revenue cycles consistent.
Follow these RCM best practices or outsource the entire revenue cycle management to an extended team of highly trained professionals to improve your bottom line and cash flow.
Patients are at the center of your business as a healthcare provider, and improved patient relationship management will significantly optimize your RCM while building patient loyalty. Most patients need clarification and support when navigating the payment process. When staff walks them through the payment process and options with them and offers clear communication, patients are more likely to pay on time. Staff must be trained to provide value to their patients by walking them through the payment process and building positive relationships.
Beyond investing in tools, you should invest in continually training your staff to use them effectively. Collaboration between staff is crucial to mitigate delays and keep your revenue cycle running like a well-oiled machine. For instance, billing and coding staff need seamless communication with the claims denial management person to handle the denials quickly.
Having a process in place to handle issues as they arise and mitigate them before they become bottlenecks to payment reimbursement is critical to an efficient RCM. Claim denials are bound to happen, but a high rate of denials is undesirable and problematic for the continued success and growth of your business. Regular process audits can zero in on the reasons and work towards reducing the occurrences.
Implementing financial data analytics will equip you with data on various RCM processes. Data on process performance indicators, denials occurrences, and payment hold-ups will enable you to monitor the system in real-time. You’ll be able to identify areas of concern and take the appropriate corrective actions required to streamline the process.
Healthcare businesses run the risk of never being fully reimbursed for their services. Your revenue cycle could come to a standstill or be delayed when patients do not pay for the services rendered, sometimes requiring additional staff for follow-up on payments. RCM can be optimized for patient collection by informing them beforehand of their financial responsibility, either by collecting their deductibles or discussing payment plans.
Paying medical bills can be a challenge for patients who want to pay but may require more flexibility in their payment structure. Easing the payment process with multiple ways to pay could serve to reduce delays in payment. You can make online bill payments available, such as contactless payment and mobile wallets. The easier you make it for patients to pay, the quicker you receive full payment for services rendered.
Almost all Medicare patients need insurance pre-authorization. Ensuring you have a process to check for coverage eligibility and insurance verification will help optimize bill payments. As a healthcare provider, overlooking this aspect of RCM process could lead to unpaid bills.
As a healthcare provider, you need to file claims on time before deadlines for full reimbursement. Medicare allows an entire year for filing claims, whereas private insurers only give a 90-day deadline. If you miss the deadline, then your claims remain unpaid.
Inefficient RCM can result in more claims denials, resulting in a need to implement a sound strategy to address claims as they occur. Whether it’s errors in billing or coding, lack of coverage eligibility, or issues with pre-authorization, your revenue cycle will need a more efficient process. Denials correlate to unpaid bills or lost revenue, and follow-up with each denial costs extra time and resources.