The primary motive of every medical practice is to deliver exceptional patient care, but it’s easier said than done. The difficulty stems from coordinating numerous vital business operations only marginally associated with providing quality patient care. Revenue cycle management (RCM) may be one of the most undervalued yet essential aspects of a thriving medical practice. This post aims to delve deep into the fundamentals of RCM and provide some exclusive tips that could help you implement an effective RCM strategy for your healthcare practice. 

What is Revenue Cycle Management?

Revenue cycle management describes how healthcare practitioners monitor the financial condition of each patient over time. Revenue cycle management consolidates a patient’s financial information from the registration and appointment scheduling through care and billing. RCM combines a practice’s clinical and administrative components by tracking patient medical records and administrative data, including name, billing address, insurance provider, and more.

The shift toward value-based payment and more comprehensive patient care has prompted healthcare facilities to examine their RCM practices. Adverse financial consequences and compromised quality of service delivery may result from inaccurate or fraudulent billing methods. Keeping their businesses afloat requires constant effort to enhance and streamline fundamental business processes.

Why RCM Is Important

The revenue cycle is fraught with complexity, from service provision to final payment. This causes a lag in getting paid for services rendered at the very least and outright denial of claims at the most. Furthermore, due to the sheer volume of patient data involved in RCM, inaccuracies might arise, leading to serious legal consequences. To safeguard yourself and your patient data, it is imperative to put an effective RCM strategy in place. 

Revenue Cycle Management Outsourcing: Everything You Need To Know

Overseeing RCM using in-house administrative staff is intricate. In terms of the economics behind running a medical practice, the current crisis healthcare providers are experiencing is unprecedented. It may be possible to cut costs and devote more attention to patient care by outsourcing the entire RCM process. Here are some of the benefits of outsourcing RCM: 

  • Decrease in operational costs and increased revenue recognition
  • Extensive focus on patient care rather than on administrative tasks
  • A clear overview of the financial health of the practice 
  • Higher payments settlement ratio
  • Access to a global talent pool

Revenue Cycle Management Outsourcing: The Dos and Don’ts

Do(s)

Discover revenue leakage and fix it

Billing inconsistencies should be settled before they are sent out. Many medical facilities either don’t make an effort to perform an accurate revenue reconciliation or wait until it’s too late. The current tendency among healthcare systems is to use EHRs that focus on the clinically driven revenue cycle. This means that doctors and other medical professionals play a vital role in the process. 

Leverage technology

All of your claims can be automatically denied if you haven’t invested in technology to remain informed with diagnostic codes and copay regulations. Even if your claims are settled eventually, the actual settlement amount might not even cover your costs. Reinvestigating denied claims and resubmitting them can be a tedious process but can be made easier with the help of technology. It can be challenging to design and deploy cutting-edge solutions in-house, which is why many businesses now turn to external IT consulting firms for help. Experts who provide healthcare revenue cycle management services can boost your practice’s productivity in weeks or months.

Audit new systems during implementations

While it makes a lot of sense to dive right into it, it is advisable to put proper auditing procedures in place to assess how well the newly established systems work. It is important to ensure that the systems you have put into place are working rather than trick yourself into thinking they are. 

Don’t(s)

Neglect patient care because of RCM

A healthcare organization understands the importance of cultivating positive patient relationships. Loyalty to a clinic can be fostered when staff members take the initiative to boost patient satisfaction and encourage a pleasant rapport. Staff should explain a patient’s financial obligation and payment choices verbally and in writing and temper their expectations. Establishing clear communication is key to letting the patients know they can trust you, given how confusing insurance claims and copayment options can be. 

Delays in filing claims

Many healthcare institutions miss claim-filing deadlines. Medicare claims can be filed one year after service. However, many private insurers only allow for a window of  90 days. If deadlines aren’t met, clinical services must be written off. Processes must be put in place to ensure that all deadlines are met. In addition, navigating claim denials can also be a challenging process. A denials prevention program should be created for the entire team focusing on standardized practices in navigating claim denials. Factors like insurance eligibility verification must be considered when a patient schedules an appointment. 

Miss reports from outsourcing partner

You can monitor and adjust any procedure aspect when billing is handled internally. While outsourcing will inevitably result in some degree of lost control, working with the proper partner will ensure that you are always aware of where you stand with regular reporting. 

Conclusion

The fundamental goal of every medical facility should be to provide outstanding care to patients. Revenue cycle management is one of the most underappreciated yet crucial parts of a successful medical practice. The journey from service delivery to payment is a critical part of the revenue cycle, riddled with complications at every stage. The ability to navigate through each of those complications is essential to running a successful medical practice.

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