Insufficient implementation of revenue cycle management (RCM) strategies may result in disorderliness. Conversely, optimizing RCM in conjunction with billing and collection procedures can mitigate the difficulties, leading to amplified revenue for the practice.
The Role of RCM in the Healthcare Sector
RCM encompasses both the clinical and business aspects of healthcare institutions, linking patient care data with administrative data such as patient names, payer details, and other personal information. An important aspect of RCM is interacting with insurance companies.
In addition, the following are key functions of a successful RCM:
• Transforms medical services provided into billable charges
• Submits claims to relevant insurance providers
• Determines patient account balances and collects payments
• Gathers necessary information for smooth patient on-boarding, meeting financial, regulatory, and clinical criteria, and generating medical record numbers
• Processes payments, accepting or rejecting them through remittance processing
• Follows up with insurance companies and patients for reimbursement
1. Effective RCM Strategies
Having grasped the significance of revenue cycle management (RCM) in the healthcare industry, comprehending the strategies becomes more feasible.
The subsequent are the five foremost tactics to enhance your practice revenue:
2. Stay Updated with RCM Technologies
It is essential to utilize the most up-to-date technology and healthcare IT solutions to ensure that the administrative team and billers accurately code claims and comply with insurance companies’ requirements. This approach can optimize the claim submission process by reducing errors and delays.
When implemented appropriately, advanced technologies such as machine learning (ML) and artificial intelligence (AI) can revolutionize your entire back-office RCM procedures, resulting in a more efficient, seamless, and user-friendly experience for billers, payers, and patients. Consequently, automated software can reduce the time, effort, and cost spent on billing, coding, and eligibility verification.
3. Train RCM Staffs
Generally, administrative staff handles front-end duties, while a separate back-office department is responsible for back-end activities like claim submission, editing, and resubmission.
Nonetheless, if you train your staff on the RCM workflow, they will have a comprehensive understanding of the entire revenue cycle. Consequently, your administrative team can collaborate with the back-office staff to enhance the revenue cycle and ensure a consistent cash flow.
When implemented appropriately, advanced technologies such as machine learning (ML) and artificial intelligence (AI) can revolutionize your entire back-office RCM procedures, resulting in a more efficient, seamless, and user-friendly experience for billers, payers, and patients. Consequently, automated software can reduce the time, effort, and cost spent on billing, coding, and eligibility verification.
4. Prioritize Patients’ Needs
Many patients find the medical billing process to be intimidating and overwhelming. Therefore, clinical staff should receive training to offer verbal and written explanations to patients regarding payment options, financial obligations, and what to anticipate during their next visit. By communicating all requirements to patients effectively, you can expedite the claim submission and reimbursement processes.
Moreover, when billing and administrative staff are well-trained and empowered to take action, they can enhance patient satisfaction and establish favorable relationships.
5. Automate Your RCM Workflows
Achieve greater revenue through successful RCM implementation, incorporating workflow automation is a crucial strategy. The following workflows are recommended for providers to prioritize in their automation efforts:
• To move faster automate the front-end tasks
• Migrate patient files and create non-patient files when needed
• Verify Patient Information
• Add coded comments automatically to mitigate coding errors
• Update outdated and add missing policies before the patient’s visit
• Verify patient’s insurance eligibility before the appointments
By automating front-end activities, you can significantly decrease the rate of claim denials, which commonly occur due to errors in the initial stage of RCM. This is particularly true for missing patient information or inaccurate coding. Therefore, automating these processes can not only lower the claim denial rate, but also make your revenue cycle more efficient and cost-effective, ultimately leading to increased profitability.
6. Perform Regular Audit
Regularly auditing your implemented RCM is another effective strategy to guarantee increased revenue. This will enable you to pinpoint the root cause of any decrease in clean claim percentage and take corrective measures to address it entirely.
Here are some key metrics to evaluate the performance of your revenue cycle management (RCM) system:
• Average payment turnaround time for claims
• Measurement of bad debts, which involves dividing the total written-off amount due to allowed charges
• Review of claim denial rate to identify the underlying reasons
• Calculation of both net and gross collection ratios to assess the efficiency and success of the RCM system in collecting payments
Implementing these strategies can be instrumental in optimizing your revenue cycle. However, if you find it challenging to adopt these best practices, you may want to consider outsourcing your revenue cycle management service to a professional company.