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As a healthcare provider, your focus should be caring for your patients and delivering positive patient outcomes. However, it is also essential to acknowledge that effective revenue cycle management is crucial to running a successful hospital practice or healthcare organization.
Revenue cycle management (RCM) is a process of handling all the financial aspects of a healthcare organization, from when patients schedule an appointment with the provider to when the healthcare provider receives payment for the services they provide to the patient.
RCM ensures healthcare providers receive accurate and timely reimbursement for the services they provide to their patients, allowing them to continue delivering the highest quality care to their patients.
Here are 10 best practices to optimize your healthcare revenue management cycle.
1. Collect Complete and Accurate Information
Make sure to gather all the necessary information about the patient accurately, whether it’s done via a phone call or online booking platforms, or at the front desk of the healthcare organization. Ensure that the details collected from the patient are complete and error-free and every detail matters from a billing perspective.
Always double-check the insurance details of the patient. It is beneficial to look for their insurance’s validity status, changes in the insurance package from the last visit, changes in the location, and under whose name the insurance is taken. Collecting accurate data will help in proper billing and payment processing.
2. Transparent Financial Communication
This is essential to build trust with the patient and help them understand their financial responsibilities. This provides patients with clear and upfront pricing information for their medical care, helps them understand their insurance coverage, including deductibles, copays, and out-of-pocket expenses, offers them cost estimates for specific treatments or procedures, and provides them access to financial counselors who can assist them in navigating insurance plans, understanding medical bills, and exploring financial assistance program.
3. Automate Process
Automation means using computers and special software to do some work your staff must do. It is a key component in optimizing healthcare revenue cycle management. Automation can help with important tasks such as checking insurance, making claims, handling payments, reminding you of your appointments, etc. An automated system can enhance patient satisfaction, streamline workflow and allow healthcare providers to spend more time with the patients.
4. Train Staff
For RCM optimization, it is important to ensure that the staff members are properly trained and knowledgeable about the process of RCM. By providing your staff with ongoing training and education, you can ensure they have the necessary knowledge and skills to manage the revenue cycle effectively. Staff training includes training in using the latest software, coding, billing updates, and communication skills.
5. Streamline Claim Submission Process
Streamlining the claims submission process is a good way to minimize payment delays, reduce administrative burdens, and optimize your revenue cycle management. It is advisable to use electronic claim submission whenever possible to reduce processing time.
6. Timely File Claims and Track Them
Medicare allows one year to file claims from the date the patient receives services, while many private insurers allow only 90 days. So, if claims are not filed on time, they can go unpaid, and the practice must write off medical services. Therefore, always file your claims promptly and do not miss filing deadlines.
To optimize your healthcare revenue cycle management process, closely monitor the status of the claims sent to the insurance companies or the payers for reimbursement. This will ensure timely payment and identify any issues or delays in the payment process.
7. Denial Management
It is also crucial to follow up with the insurance companies or payers to understand the reason for denied claims, correct any errors, and resubmit the claim if necessary.
Implementing a denial prevention program for the entire staff is also recommended, focusing on standardized processes to eliminate denial risks.
8. Monitor Key Performance Indicators
Regularly track and monitor key performance indicators (KPIs) to identify any areas of improvement. Common KPIs you should track and monitor include denial rates, days in accounts receivable, and a net collection rate. This will allow you to make data-driven decisions to improve your revenue cycle management. For example, a high claim denial rate could be due to billing or coding error that needs to be addressed.
9. Review Your Contract
Reviewing the contracts with the vendors or payers is crucial to optimize revenue cycle management. Regular contract reviews ensure that healthcare providers are reimbursed appropriately for their services. This also allows healthcare organizations to negotiate better pay terms.
10. Ensure Compliance
As a critical aspect of revenue cycle management, compliance ensures that healthcare organizations comply with the regulations and industry standards, including billing guidelines, HIPAA regulations, and other legal requirements. Healthcare organizations that fail to comply with the regulations bear financial personalities and reputational damage.
Revenue Cycle Management in Miami FL
If you are struggling with revenue cycle management and are looking for a partner who can help you optimize your financial performance? Contact Premier Physician Support Services. As a medical services organization, we offer physicians and healthcare organizations a comprehensive range of services, including revenue cycle management services, to allow them to focus on what they need to do, i.e., provide quality patient care services.
To know how we can assist you in your revenue cycle management process, contact our staff today at (305) 273-9100.
