7 healthcare RCM lessons: What high-performing medical practices already know
Why do some medical practices seem to thrive while others struggle to keep their doors open? Though there’s no universal formula for success, we’ve done some research to identify seven important revenue cycle management (RCM) lessons that high-performing medical practices have already learned. Apply each lesson to your own unique circumstances and business challenges to promote long-term financial sustainability.
(Note: While you check out these important medical billing lessons, be sure to also adopt revenue-boosting mantras that can help you create a positive workplace culture—both go hand in hand!)
Lesson #1: You can’t improve what you don’t measure.
High-performing medical practices know that operational and RCM key performance indicators (KPI) provide valuable insights into problem areas that, if left unaddressed, could lead them down a long and winding road toward business failure. That’s why these medical practices continually measure and monitor KPIs for clues. Examples of operational KPIs include no show rates, cancellation rates, patient portal use, and staff retention rates. Examples of revenue cycle KPIs include total medical revenue after operating costs, gross revenue, claim denial rates and denial write offs, and accounts receivable days.
Lesson #2: Technology is not the enemy.
While it may seem daunting to leverage technology for certain revenue cycle tasks, high-performing medical practices know that doing this can actually enhance revenue integrity, boost medical billing staff productivity, and improve revenue cycle cashflow. Here are a few examples of healthcare RCM technology that can help move the needle on all of this and more: Online patient bill pay, mobile patient check-in, automated patient eligibility, and automated patient appointment reminders. Lean on your RCM vendor to provide training and support to help you maximize the return on investment.
Lesson #3: Ask patients what they need. Then listen and act.
High-performing medical practices know they must have a constant pulse on what does and doesn’t resonate with patients. That’s why they frequently survey them and ask for input and feedback. Then they make changes to improve the patient financial experience as well as the clinical one. Perhaps its extended office hours, patient engagement technology, a modernized waiting area, or more culturally competent healthcare. Medical practices that attract and retain patients are those that listen carefully and respond.
Lesson #4: First (online) impressions matter.
Seventy-two percent of U.S. adults read online patient ratings and reviews when choosing a physician or healthcare facility. Half of U.S. adults read 10+ reviews, and 23% read 20 or more when selecting care. These and similar healthcare consumer statistics are why high-performing medical practices optimize their Google Business profile, invest in search advertising, leverage social media, and update the medical practice website.
Lesson #5: It pays to get it right the first time.
We’re talking about claim submission. High-performing medical practices strive for clean claims to promote smooth cashflow and avoid costly, time-consuming appeals on the back end. They know it pays to invest in physician and coder education to avoid common medical coding mistakes, leverage claim scrubbers, and perform internal coding audits—all with the goal of getting paid accurately and in a timely manner. If denials do occur, high-performing medical practices immediately drill down into the root cause so they can avoid them in the future.
Lessons #6: Payers won’t pay you more if you don’t ask them. But they might if you do.
High-performing medical practices know when payer contracts are up for renewal and make a data-driven argument for why they deserve to be paid more. The flip side of the coin is knowing when to walk away. Be especially mindful of payers who promise an overall percentage increase but a decrease for specific high-utilization codes that would actually cause the medical practice to lose money. Performing due diligence during payer contract negotiations is critical.
Lesson #7: It’s ok to ask for help.
Although high-performing medical practices strive for medical billing staff retention through competitive salaries, benefits, and other perks, they also acknowledge the ongoing medical coder shortage and the fact that there are times when the demand for revenue cycle experts may simply outweigh the supply. That’s when they immediately turn to a trusted outsource partner for revenue cycle support. Nimble decision making helps these medical practices navigate major transitions (e.g., during spikes in claim volume, unanticipated staffing gaps, or medical practice expansion) while simultaneously maintaining operational continuity.
Conclusion
Today’s high-performing medical practices have already learned the RCM lessons described in this article (sometimes the hard way). However, they’ve ultimately come out on top—stronger and more resilient than ever before. You can do the same and follow in their footsteps to improve your revenue cycle. Learn how edgeMED can help and be sure to check the Healthy Snacks blog for more expert insights, best practices and industry trends.
