Roundup of five revenue cycle management best practices
Improving revenue cycle efficiency doesn’t necessarily take a lot of time or resources. All it takes is a little thinking outside the box. Networking with peers helps give you the validation and external perspective you need. Whether it’s online, in person, or a combination of both, other medical billers, medical coders, and practice managers may be able to help you solve some of your biggest revenue cycle management (RCM) challenges. The American Academy of Professional Coders, Medical Group Management Association, and Professional Association of Health Care Office Management can be great resources.
In the meantime, here’s a roundup of five RCM best practices:
1. Think broadly when it comes to RCM. Running a smooth revenue cycle means you’ll need to submit timely and accurate medical claims. Although you have a full year to file a Medicare claim, many commercial insurance companies only give you 90 days. If you miss the deadline, you may forgo payment. However, timely claim submission is only one piece of the puzzle. Here are three additional pieces of RCM required to promote revenue integrity:
Provider credentialing and enrollment. Lapsed credentials and failing to enroll new providers are two of many mistakes that can easily lead to lost revenue, delayed payments, out-of-network services, and denials.
Patient eligibility. With the rise in high-deductible and cost-sharing insurance plans, it’s more important than ever to verify eligibility before services are rendered.
Patient collections. Patients are increasingly responsible for most of the healthcare bill, and failing to implement best practice solutions can lead to revenue loss and aging accounts receivable. These best practices include collecting the copayment and deductible at the time of registration, setting up flexible payment plans, and planning ahead for patient objections so staff know how to handle scenarios appropriately and with empathy.
2. Create a patient-centric revenue cycle. A patient-centric revenue cycle runs smoothly and efficiently. That’s because patients know what to expect and can pay their medical bills easily. To take this approach, do the following:
Provide cost estimates. Cost estimates not only help you comply with the No Surprises Act; they also increase trust and patient engagement. They may also help you improve up-front collections.
Revise patient statements. Look at your statements. Is it reasonable to think that most patients would understand what they owe and why? If not, how can you improve it?
Make it easy for patients to pay. Provide options, including online bill pay, portal-based payments, kiosk-based payments, and more.
3. Establish and monitor key performance indicators (KPI). A financially stable medical practice is one that maintains a smooth cashflow. To do this, you need to establish and monitor KPIs regularly. KPIs help you understand the financial health of the medical practice and identity whether you’re experiencing any revenue leakage. At a minimum, these KPIs should be on your radar:
Clean claims rate
Cost to collect
Days in accounts receivable
Denial rate
First pass payment rate
Net collection rate
Patient satisfaction
Monitor these KPIs daily and compare month-to-month averages. Doing this will help you spot trends more easily so you can address areas of deficiency quickly.
4. Create a denial management workflow. It’s not a matter of ‘if’ you’ll get a denial—it’s a matter of ‘when.’ When denials occur, how will you even know? Who will be responsible for monitoring feedback from your clearinghouse and payers? Who will work those denials? Will you assign certain individuals to certain types of denials? Certain insurance companies? You’ll need to identify the root cause of the denial, correct any errors, and resubmit the claim in a timely manner.
5. Look for opportunities to modernize your revenue cycle. For example, can you leverage technology to automate certain steps? What about software to provide real-time analytics that help you identify and resolve issues quickly? What about mobile access to the electronic health record (EHR)? Providing staff with tablets and smartphones with a mobile EHR app may improve RCM efficiency because they can capture billing information at the point of care.
Conclusion
Using these and other revenue cycle best practices can help you increase cash flow, decrease account receivables, reduce expenses, streamline workflow, and gain greater control of your business. Learn how edgeMED can help and be sure to check the Healthy Snacks blog for more expert insights, best practices and industry trends.
