Healthcare organizations must make sure they have a strong and reliable revenue cycle management (RCM) process in place. As in the constantly changing world, healthcare rules and emerging reimbursement models evolve.
Here are the best practices in revenue cycle management to guide you in creating and executing a successful RCM program.
Before we proceed, it is important to have an initial understanding of what actually is revenue cycle management in healthcare.
Read: “How to Boost Ambulatory RCM Performance“
What is Healthcare Revenue Cycle Management?
It is like a money-tracking system used by healthcare facilities. They use special tools to follow a patient’s journey from when they sign up and make appointments to when they finish treatment and pay their bills.
8 Best Practices in Revenue Cycle Management
1. Begin by Collecting Ample Information!
The role of the patient is a significant contributor to the healthcare economy. It is essential to gather comprehensive personal information right from the moment a patient initiates their care-seeking journey, possibly even before their scheduled appointment.
This data not only forms the foundation for the following claims processing but also determines the approach for securing patient payments or establishing suitable arrangements for outstanding balances.
Effective communication further aids patients in understanding their coverage advantages and potential options for treatments.
2. Collect Patients’ Payment Promptly
Among the most challenging aspects of revenue cycle management is collecting patient payments. The act of gathering these payments promptly plays an important role in sustaining the continuous flow of finances within your organization.
Simplifying this process involves cordial communication with them and guiding patients through the complexities of the insurance procedure, enabling them to comprehend their financial obligations well in advance.
As medical deductibles rise, an increasing number of patients find themselves responsible for higher payments.
Consequently, they might require assistance in arranging suitable financing or payment plans before undergoing any non-emergency procedures.
3. Simplify Revenue Cycle Management With a Single Provider
Certain healthcare organizations employ multiple vendors to handle various aspects of the revenue cycle, leading to additional time and effort spent on administration.
Focus on centralizing your revenue cycle management tasks with a sole provider capable of delivering eligibility verification, claims management, and patient payment processing.
This unified and comprehensive approach will streamline workflows, enhance staff productivity, and simplify the billing process for patients, ultimately aiding them in comprehending and fulfilling their financial responsibilities.
4. Timely Claim Filing
Numerous healthcare institutions struggle with timely claim filing, leading to the neglect of crucial deadlines.
While Medicare offers a year-long window for claims submission from the service date, various private insurance firms enforce a stricter 90-day limit.
Not meeting these deadlines results in unpaid claims and necessitates healthcare providers to absorb the costs of providing clinical services. Implementing effective processes is vital to ensure these deadlines are met consistently.
5. Invest in Technology
Utilizing technology can have a notable impact on enhancing the effectiveness of healthcare (RCM). Various tools can facilitate the automation of numerous procedures within the revenue cycle, encompassing billing, claims administration, and denial handling.
These tools can also give you instant data insights, which can help you quickly find and fix problems.
6. Develop an Effective Denial Management Process
Failure to follow the aforementioned best practices in revenue cycle management could lead to the denial of claims. It is of utmost importance for hospitals and medical facilities to consistently monitor and record these denials, as this process plays a crucial role in recognizing patterns and determining the fundamental reasons.
Instituting a program dedicated to preventing denials is essential for the entire staff, concentrating on establishing uniform procedures to minimize the probability of claim rejections.
Effective denial management strategies, in line with industry best practices, have the potential to bring down accounts receivable, enhance cash flow, diminish the frequency of denials, and decrease the overall cost associated with the collection process.
7. Establish Professional Growth Initiatives
Ensuring accurate coding and processing is among the most effective strategies for minimizing denied healthcare claims.
Healthcare providers need to establish consistent educational initiatives for their staff. These programs should emphasize correct coding methodologies, thorough chart documentation, and reinforcing financial policies.
Besides simply preventing medical errors, such training can also contribute to decreasing staff turnover rates.
8. Getting Better Every Day
Even if your revenue cycle is running smoothly, don’t fall into the trap of satisfaction. Maintain a proactive approach to ensure peak performance, maximizing both cash flow and net revenue. Utilize your data to identify paths for boosting income and optimizing expenditures.
This might involve cost-cutting, reducing denials, and tackling issues like bad debt and underpayments. The goal is to continuously strive for excellence rather than simply maintaining the current condition.
Benefits of Revenue Cycle Management With Wise Medical Billing
1. Adherence to Regulations
Complying with healthcare regulations can pose challenges due to their constantly evolving nature.
Relying on the expertise of a Revenue Cycle Management (RCM) specialist at WMB can provide assurance that your organization stays aligned with relevant regulations and obligations, including but not limited to HIPAA and CMS guidelines.
We maintain a team of dedicated experts who are continuously monitoring the environment for any changes, and then sharing this knowledge with the rest of our team.
2. Enhanced Financial Performance
Collaborating with us has the potential to enhance your revenue cycle management procedures, leading to increased accuracy and promptness in billing, minimized claims rejections, and quicker reimbursement. Consequently, this will contribute to heightened financial success for your healthcare establishment.
3. Making Patients Experience Better
Patients highly value precise and transparent billing, and quicker reimbursement processes can help to minimize financial stress and anxiety.
Within WMB teams, advanced communication platforms are utilized for patient engagement. All interactions are meticulously recorded and undergo AI analysis, allowing for the assessment of overall patient sentiment.
Through scheduled or on-demand detailed reports, areas with potential for enhancement are identified, providing ongoing prospects for refining the patient experience.
Consult With Our Revenue Cycle Management Experts Now!
When it comes to enhancing your revenue cycle management process, our team of experts at Wise Medical Billing is here to assist you. Don’t miss out on the opportunity to optimize your revenue. Reach out to us now for a free quote and take the first step toward maximizing your financial potential.