You could be an outstanding urgent care facility and nevertheless lose money due to inadequate e-management practices, and you may not be aware that this is taking place.
Optimizing this area of your business won’t only affect your bottom line, but it could make life easier for your employees and make it easier for patients to pay.
To help you determine the best way to allocate your efforts to be successful, we’ll dispel the confusion related to managing revenue cycles and describe how you can start seeing outcomes as early as next month.
What is Revenue Cycle Management (RCM)?
In the field of healthcare, revenue cycle management is the whole process of identifying, monitoring, and collecting patient service revenue. It encompasses all administrative and clinical aspects of this cycle of revenue, ranging from registration to the full payment for services provided.
A successful healthcare revenue cycle system combines technology and operating procedures that are standard and well-trained personnel and, for certain clinics, an outside billing service to guarantee a maximum revenue return. If you don’t have a well-organized and properly executed revenue cycle management procedure, your staff could have to put in more time and work on rejections and rejections.
Here is some basic information on the management of revenue cycles in healthcare, which can help you understand how to make the most of it.
Technology can Assist
In the field of managing the revenue cycle for healthcare, technology can assist you in reducing the number of exceptions, boosting efficiency, improving accuracy, and remaining in compliance. A majority of automated billing software is built into software for managing practices. We will go over this in the final section of the RCM software.
Your SOPs will ensure that your staff is aware of the appropriate steps to adopt. It is important to set up best practices in every aspect of the cycle of revenue and include them in your SOP.
Training for your employees should be continuous and cover a variety of areas to benefit from managing the revenue cycle in the field of healthcare.
Your front desk is in charge of handling the majority of all revenue cycles, and they must know how to recognize and avoid common errors and be confident in making requests for payments from patients. Furthermore, your employees must be educated on accurate coding, which has been a major issue since COVID-19.
While smaller clinics may be able to handle the billing for urgent medical care independently, Some prefer to put billing management into the control of a billing firm that is skilled in healthcare rather than hiring a biller for the staff. Once you reach a certain level of growth, choosing an experienced medical billing service is the simplest and most efficient method for handling your billing.
If you’re working with a reputable revenue cycle management service provider, you can be sure they’ll be able to offer this service, too.
Benefits of Revenue Cycle Management
Beyond visit volumes and type of visit, healthcare revenue cycle is the most significant factor in the potential of your revenue. In most cases, it’s when something happens at the backend of the rev cycle, such as denials or rejections, it’s a sign of something that was not working properly on the front end.
This is why success in managing the revenue cycle for healthcare is a matter of setting up your own internal processes that make sure that things are done as follows:
- You’re currently on all contracts and credentials.
- Staff members are aware of the subtleties of the top five to ten payees
- The staff is trained to interpret and read Real-Time Eligibility and what to do with the information
- The staff adheres to the procedures for operation that you have established
Revenue Cycle Management Process Explained
Revenue cycle management for healthcare encompasses the entire process of the revenue cycle. It comprises:
- Preregistration – collecting patient data (like insurance information) prior to the time the patient is expected (often via the Internet for interaction with the patient)
- Registration – collecting patient information that was not recorded during preregistration
- Medical care into billable charges
- Coding is the art of accurately codifying the visitor
- Claim submission – sending invoiceable charges to insurance companies
- Remittance processing, patient billing, and resolution
- Follow-up on insurance – collecting payments from insurance companies
- Collection of late or outstanding balances
How to Get the Best ROI With RCM
Monitoring your revenue cycle management in healthcare KPIs can help you identify the areas for improvement, but they do not tell you how. Here are some practical strategies that our experts suggest to help you optimize your staff’s performance across the entire revenue cycle.
Preregistration and Registration
Registration and ineligibility errors are the most common reason for a rejection. This is a good first step to take when optimizing your procedure.
The ability for patients to register online can make it easier for your staff and assist in reducing errors in data entry. When the patient arrives at your clinic, the staff will use insurance eligibility tools like Real-Time Eligibility (RTE) as well as Real Time Verification (RTV).
This will immediately inform you whether the patient’s insurance includes the services. In addition, your staff should prepare an action plan in the event that RTE or RTV confirms that the patient isn’t covered. Train your employees to solicit credit cards or establish an installment plan.
Charge Capture and Coding
In the year that you consider that the American Medical Association came out with updated coding guidelines for COVID-19 in 2021; this marked the first time that in over 25 years, providers were required to master new codes -to learn new codes – and be aware of regular updates to the codes.
The best method to ensure that your coding remains correct is to offer continuous training. PerigonMed is committed to providing webcasts and other resources that help understand what medical services translate to billable costs.
Claim Submission
If the front office team is doing diligent work at the front, and your providers are making accurate claims, your claims are already more streamlined. To make sure that the process is perfect, find the most commonly made mistakes when filing claims, establish best practices for the most common mistakes, and rectify them prior to making the claim.
Insurance Follow-up
It is usually regarded as the most difficult part of the healthcare revenue cycle. If you are looking to be paid, you must be able to make a plan for when you should call or make an online request to insurance companies asking for payment.
We suggest that you set a timer for each payee to contact them every 30 to 45 days. Set aside time to conduct this follow-up and create separate cadences for each payer. You do not want to be a burden on your work by calling all of them at the same time every month.
Patient Collections
This is another area that can be a challenge for many clinics with regard to the management of revenue cycles in healthcare because very few people are willing to solicit money from patients.
Two ways to make this easier are: A) discover which staff is the most comfortable with the task, and B) coach the staff with a plan to help them understand what to do.
