Ways To Improve Revenue Cycle Management In Healthcare

Revenue cycle management (RCM) is a crucial element in running a successful medical practice. RCM is the financial process used to track patients’ care journey right from when they first initiate contact with the practice to the final payment due for services rendered. To ensure the financial health of your practice, it is important to fully understand the RCM process and to look for ongoing ways to improve it.

The Stages of Revenue Cycle Management

RCM, although essential for a business to run successfully, can be a complex process. Simply put, the revenue cycle is used to track the financial transactions of a practice and to process the information effectively. It ensures a practice has all the necessary information to do their job successfully and to be reimbursed for their care delivery in a timely and efficient manner. With improved revenue, it allows practices to invest more money and time into patient services and treatments.

The revenue cycle is a step-by-step process that includes all the different aspects of a healthcare business that contribute to the capture, management, and collection of patient service revenue. These stages include:

• Patient intake and insurance eligibility verification – To obtain essential information from the patient and to determine the level of insurance coverage a patient has, what care they are eligible for, and to how the practice will recover their costs.
• Charge capture – Where medical services provided by the physician are rendered into billable charges.
• Coding – Billable charges, including diagnoses, treatments, and procedures are all coded (using appropriate medical industry coding).
• Claim submission – Claims of billable fees are submitted to insurance companies with a summary of care, who will then calculate the amount to be paid to the provider.
• Ongoing communication with insurers – Such as verifying a network, querying claims/following up on the claim status, or negotiating contract rates.
• Patient collections – Any remaining balances are billed to the patient.
• Remittance processing – Claims are received by the payer and reimbursed or rejected.
• Denials and appeals – Billing team attempts to resolve denials, follows up on denial status, or starts the appeal process.
• Patient follow up – To collect any outstanding balance due.
• Utilization review – Medical services and policies to be regularly reviewed to reduce any unnecessary expenses and to maintain good medical practices.

Improving Revenue Cycle Management

Ensuring a practices revenue cycle is streamlined is essential for a business to run effectively and to provide quality care to patients. The good news is that there are things you can do to improve revenue cycle management in your healthcare business.

Improving revenue cycle management involves continually reviewing and implementing the necessary changes to support an ever evolving healthcare system. This includes focusing on key areas, such as:

• Improving staff training – Often members of staff will only deal with specific areas of RCM, which can lead to potential challenges in tracking each step of the process effectively, particularly if there is any missing documentation or inaccurate information somewhere along the line. Staff should receive training in all areas of RCM to ensure they have a clear understanding of the full revenue cycle process to help make it more efficient and seamless.
• Simplifying the patient access process – This helps ensure complete and accurate patient information is gathered from the start to avoid potential problems and errors later on, which could result in reimbursement delays or claims denials. It is not uncommon for there to be confusion in areas such as a patient’s eligibility for treatment and determining what is and isn’t covered within a patient’s insurance policy. The patient’s eligibility and insurance coverage should be clarified and confirmed at the preliminary stage before any treatment begins.
• Keeping up with changes to payer rules – Rules concerning the claim submission process and other factors, such as which codes to use, are constantly changing, which can delay the claim process and be costly in both time and financially. Understanding and keeping up to speed with payer rules is an important way to ensure the claims process runs smoothly and efficiently.
• Making the payment collection process easier – There can be delays and problems in capturing patient payments, such as patients with co-pays or those who have a shortfall in their coverage. By offering solutions to patients who may find it difficult to pay outstanding balances can improve the revenue cycle process. This may include offering payment plans or incorporating easier ways to pay, such as with online payment facilities, Apple Pay, and credit card facilities.

How Outsourcing RCM Can Help

One of the best ways to improve your RCM is to consider outsourcing it to a third-party company, such as a management services organization (MSO). An MSO is an organization that provides a range of administrative and business-related support to medical practices and other healthcare organizations to help a business run more effectively.

An MSO consists of experienced and knowledgeable staff who are trained to manage different areas of the business, such as coding, billing, and collection services, risk management, personnel, and human resources. They use advanced information systems and technology to streamline procedures and help practices manage their nonclinical and management activities more efficiently.

In addition to having access to advanced information systems and technology to improve the billing, coding, and payment collections process, they also have specialized expertise in a range of other areas, such as providing actionable management reports and offering training and development opportunities for staff.

Outsourcing RCM and other business-related duties to an MSO can help organizations to operate more efficiently and better focus their efforts on other key areas, such as providing high-quality patient care. An MSO can identify effective ways to improve the revenue cycle process and management of your business to help it succeed in an ever changing healthcare system.

Management Services Organization in South Florida

To improve the revenue cycle management of your business, seek the expertise of Premier Physician Support Services. We are a management services organization (MSO) owned and operated by physicians and experienced healthcare executives with a combined 50 years of managed care experience.

We provide a range of services to help you keep on top of the non-medical aspects of your business. We focus of three main areas of expertise, including improving business infrastructure, using advanced information systems to help manage revenue cycle and other administrative duties effectively, and providing incentives for quality and cost-effective care.

If you would like to learn more about how an MSO could help your business, contact the expert team of providers at Premier Physician Support Services today at (305) 273-9100. We are here to help your healthcare practice succeed.