You can do a lot of things to maximize the success of your medical practice. However, regardless of your size, needs, and policies, one process that can help your healthcare organization grow is the revenue cycle.
Revenue cycle management, or RCM for short, is the process through which health care organizations track patient care from the moment they call for an appointment until the last payment is registered. This cycle consists of all the administrative and clinical measures taken to capture and manage a patient. It’s the life and blood of any healthcare organization.
With that in mind, here are the main components of the revenue cycle and what you need to know about them to ensure that your organization is thriving.
Here are some of the steps you need to follow to maximize your profitability with revenue cycle management:
Scheduling and Pre-Registration
To understand just how important this step is, think of the following scenario. A patient calls to make an appointment, and while on the phone, you do not get all the necessary information from them. You fail to realize that you don’t accept claims from their payer. The patient comes in for their appointment, at which point you figure out you’ve wasted time and resources for a patient that is not compatible with your organization.
Front-end collections are, as previously mentioned, crucial in the revenue cycle process. Make this step mandatory and ensure that the entire staff is familiar with the necessary estimation and payment tools. The financial impact of this basic step is substantial: point of service collections can generate cash, divert debt, and reduce expenses.
Pay Attention to Utilization Review and Case Management
Case management (the coordination of services on behalf of a patient) and utilization review (the process of reviewing whether a treatment is medically necessary) are vital for cost controlling in any healthcare organization.
Improve the Charge Capture and Coding Process
Charge capture is the process health care providers use to record information about the services they provide and then translate it according to the coding used in the healthcare system.
Be Careful about the Claim Submission Process
The claim submission process should not present difficulties, as long as you have the necessary and correct data and handle it with attention. Do not forget that each carrier will have a specific timeframe for filing a claim. Be aware of it and respect it.
Medical Third-Party Follow-Up
Follow-up is at the core of any medical billing process and is the key to maximizing collections. That’s because it can help you determine the resolution for each of your patients’ accounts. The process will require conducting proper investigations and analysis, and constant contact with insurance carriers.
Know How to Handle Rejections
Payment and remittance advice transactions are used to provide additional explanations for transfers of funds from a health plan to a health care provider.
Understand How Payment Posting, Appeals, and Collections Work
The last and probably one of the most important steps in the revenue cycle management process is payment posting. Although it may look like an easy task to handle, payment posting can have a huge impact on your practice’s financial performance. Payment posting allows you to examine the revenue cycle and optimize it. That can lead to an increase in your revenue.
Tech Solutions That Can Help Your Streamline RCM
It can be hard for your organization to keep pace with the revenue cycle management process. A tool can take some of the burden off your shoulders. Here are some of the best tech solutions you should consider:
Unify Your Systems
Many times, revenue cycle systems are put aside and isolated from the rest of the organization’s elements. This approach affects your ability to reach your maximum potential. A better way would be to consider the relationship between integrated software and hardware systems and use it to achieve a clearer overview of your patients’ clinical situations.
Implement a Billing and Claims Management System
Claims management plays a vital role in minimizing denials. Training your employees to deal with denials will not only reduce the number of errors that occur in the billing process but also improve your bottom line.
Healthcare organizations should constantly be on the lookout for opportunities to grow their revenue. In other words, they need to be prepared for negotiation sessions and making contract adjustments. That’s where a tool that can help them track, monitor, and analyze data can come in handy.
Medical coding is a crucial element of the healthcare system that allows the efficient transfer and management of massive amounts of patient information and data. International Classification of Diseases (ICD) codes was established by the World Health Organization and are used to identify a patient’s condition, as well as a doctor’s diagnosis. If the diagnosis coding does not justify the procedure or treatment the patient underwent, then a claim is very likely to be rejected. Coding plays a crucial role in the revenue cycle. Even the tiniest mistake can lead to serious financial issues.
Clinical Documentation Solutions
Clinical documentation programs are linked to the coding process, and their relationship is vital for maintaining a healthy revenue cycle. Clinical documentation is the basis of coded data and contains the patient’s clinical status. That means its accuracy is essential, putting it at the very core of any encounter with patients. Fortunately, there are several clinical documentation programs that include professionals, processes, and the specific technology necessary to keep track of patient’s information.
The revenue cycle is a complex process that involves a lot more than just collecting bills. The faster and better you understand it, the easier it will be for your practice to increase efficiency, find any weak spots, and correct them.