Optimizing earned revenue and maximizing reimbursements and patient collections is the foundation for the sustainability and growth of any medical practice.
That’s where revenue cycle management (RCM) comes in as the most powerful system for growth in the practice.
What is Revenue Cycle Management (RCM)?
RCM encompasses the entire process of capturing, managing, and collecting revenue generated by patient services. By optimizing your RCM processes, any practice can significantly improve its bottom line and free up valuable resources to focus on patient care.
This article outlines eight key RCM strategies championed by healthcare leaders to boost revenue, reduce administrative costs, and streamline practice financials. We’ll explore how these strategies can be implemented to transform your RCM and unlock the full potential of your practice’s revenue cycle.
Understanding the Revenue Cycle: A Prerequisite for Improvement
Before we go into specific strategies, let’s gain a clear understanding of the different stages in the medical revenue cycle:
- Pre-service: This stage involves patient registration, scheduling appointments, verifying insurance eligibility, and collecting patient demographics and financial information. Accurate and complete information captured here sets the stage for smooth claims processing later.
- Service delivery: The service delivery stage focuses on providing healthcare services, documenting them accurately, and using the correct medical terminology and coding conventions. Assigning the appropriate Healthcare Common Procedure Coding System (HCPCS) codes and International Classification of Diseases (ICD) codes ensures accurate representation of services rendered for proper reimbursement.
- Claims submission: Here, completed claims are submitted electronically or on paper to insurance companies for adjudication. Clean claims with accurate coding, complete patient information, medical documentation, and on time are more likely to be processed quickly and without denials.
- Payment posting and denials management: This stage involves receiving payments from insurance companies and patients, addressing denied claims, and initiating patient collections for outstanding balances. A proactive approach to identifying and resolving denials or patient questions is crucial for maximizing reimbursements.
8 Key RCM Strategies for Enhanced Revenue
Now, let’s explore the eight key RCM strategies healthcare leaders are prioritizing:
1. Leverage Technology for Automation and Efficiency
Manual processes in RCM are prone to errors and delays. Take advantage of newer RCM technology systems that streamline processes while saving time through automation.
- Appointment scheduling and confirmations: Reduce no-shows and improve patient satisfaction with online appointment scheduling and automated appointment reminders.
- Patient Estimation: Collect patient balances sooner and improve cash flow by leveraging patient estimation tools that tell patient the amount of their financial responsibility before receiving service.
- Eligibility verification: Automate insurance eligibility checks before appointments to avoid claim denials due to coverage issues.
- Coding: Leverage coding tools to aid in accurate coding and prevent claim denials.
- Claims submission: Streamline claims submission with claims edits and electronic filing tools that ensure accurate and complete claims are sent to the right payers.
- Payment posting: Automate payment posting to reduce errors and expedite the process.
- Reporting and analytics: Utilize RCM software for robust reporting and data analytics to identify areas for improvement and make data-driven decisions.
Choosing the right RCM software depends on the size and needs of your practice. Consider factors like scalability, ease of use, integration with your existing electronic health record (EHR) system, and features specific to your specialty.
2. Prioritize Accurate Medical Coding and Documentation
Accurate medical coding ensures proper reimbursement for services rendered. Investing in qualified medical coders and implementing robust coding compliance practices minimizes claim denials and ensures you capture all billable charges.
Here’s how to achieve accurate coding:
- Invest in qualified medical coders: Hire certified coders with experience in your specific specialty.
Implement coding compliance programs: Establish clear coding guidelines and conduct regular audits to ensure adherence to coding standards. - Stay up-to-date on coding changes: Coding systems like HCPCS and ICD are updated regularly. Ensure your coders are trained on the latest coding requirements.
- Utilize coding software: Consider using computer-assisted coding (CAC) software to improve coding accuracy and efficiency.
3. Emphasize Patient Pre-registration and Upfront Collections
It’s common for medical practices not to ask every patient for money when they check-in. However, collecting patient co-pays and deductibles upfront improves cash flow and reduces bad debt. Most patients appreciate the heads-up on their balances and are happy to pay.
Below are some strategies that encourage upfront collections:
- Offer online patient portals: Allow patients to pre-register online, update their demographic information, and view and pay their bills conveniently.
- Provide clear estimates: Provide patients with estimates of their expected out-of-pocket costs before services are rendered. This fosters transparency and helps patients plan financially.
- Offer flexible payment options: Offer multiple payment options like credit cards, debit cards, and installment plans to make it easier for patients to pay their bills on time.
4. Implement a Dedicated Denials Management Strategy
Denied claims can significantly impact your revenue. A dedicated denials management strategy is crucial to promptly identify denied claims, analyze the reasons, and appeal them effectively.
Here’s how to build a strong denials management strategy:
- Develop a clear process for identifying denied claims: Utilize RCM software with denial alerts or track denials through regular reports.
- Analyze denial reasons: Categorize denials by reason (e.g., coding errors, missing information) to identify areas for improvement.
- Develop a standardized appeals process: Establish a clear workflow for gathering necessary documentation and submitting appeals to insurance companies.
- Consider partnering with a denials management service: Specialized denials management teams can handle the entire appeals process, freeing up your staff to focus on other tasks.
Learn more about managing denials in this series of articles from UnisLink.
5. Foster Transparency in Patient Billing
Patients appreciate clear communication regarding their billing. Here’s how to promote transparency:
- Provide clear and detailed explanations of charges: Break down bills into understandable terms, outlining the services rendered and associated costs.
- Offer cost estimates beforehand: Inform patients about estimated out-of-pocket costs before procedures to avoid surprise bills.
- Utilize patient portals for easy access to bills: Allow patients to access and review their bills electronically through a secure patient portal.
- Establish a dedicated patient billing department: Provide a designated phone number and email address for patients to inquire about their bills and resolve any billing issues promptly.
6. Invest in Credentialing and Provider Enrollment
Timely and accurate provider enrollment with insurance companies ensures uninterrupted billing and reduces claim rejections due to incorrect provider information.
Here’s how to streamline credentialing:
- Maintain accurate provider data: Ensure all provider information, including licenses, certifications, and affiliations, is up-to-date in all insurance networks.
- Partner with a credentialing service: Outsourcing credentialing tasks to a credentialing specialist can save time and ensure accuracy.
- Proactively monitor credentialing deadlines: Track credentialing expiration dates and submit re-credentialing applications well in advance to avoid disruptions.
7. Harness the Power of RCM Data Analytics
Data can be a goldmine for improving RCM efficiency. Utilize RCM analytics tools to:
- Identify areas for improvement: Analyze key performance indicators (KPIs) like denial rates, collection rates, and coding accuracy to pinpoint weaknesses in your RCM processes.
- Track trends and patterns: Use data analytics to identify trends in claim denials by payer or coding errors by specific coders. This allows for targeted interventions.
- Benchmark your performance: Compare your RCM metrics against industry benchmarks to identify areas where you can improve.
- Make data-driven decisions: Utilize data insights to inform strategic decisions regarding staffing, technology investments, and process improvements.
8. Cultivate a Culture of Revenue Cycle Excellence
Building a team invested in RCM excellence is crucial. Here’s how to foster a culture of accountability and continuous improvement:
- Provide ongoing RCM training: Train staff on coding compliance, claims submission procedures, patient communication best practices, and the latest RCM technology.
- Promote open communication: Encourage staff to report any billing or coding issues promptly and work together to resolve them effectively.
- Recognize and reward exceptional performance: Acknowledge and reward staff members who consistently demonstrate excellence in RCM practices. This motivates them to maintain high standards.
- Set clear goals and expectations: Establish clear goals for KPIs like denial rates and collection times to hold staff accountable and track progress.
Unislink is Your Partner in RCM Success
Unislink will help you streamline your RCM processes, improve cash flow, and achieve long-term financial stability for your practice. As important, the experts at UnisLink will advise and consult on how your practice can become more viable by analyzing key performance indicators and metrics that highlight growth opportunities.
With UnisLink’s advanced RCM technology and deep industry experience, your practice will stay up-to-date with the latest industry trends toward efficiency and maximize profitability.
Contact us for more information on this topic and a free, detailed assessment on how your practice can start improving revenue and cash flow immediately.