Medical Billing

5 best practices to have a successful healthcare revenue cycle management

revenue cycle management

In a healthcare system, RCM, which is revenue cycle management, is the most crucial aspect. Through revenue cycle management, one can collect and track revenue from patients. The process of RCM begins by scheduling a patient for clinical service and continues till the final payment for the healthcare services has been collected from the patient that he or she has rendered.

Healthcare revenue cycle management constantly goes through different kinds of changes. This happens because hospitals continuously merge; they are changing the payer landscape and acquiring new providers. All these lead to a challenging healthcare system.

As per a recent survey, it was found out that the biggest threat to the revenue cycle challenge is the denial rate, which is around 76%. Then comes revenue integrity, which is 36.8% followed by patient pay, which is 34.2%. With all these challenges, it is quite apparent for the healthcare revenue cycle management to get caught up and miss the big picture. To make sure that the healthcare system manages everything well, here are five best practices that every healthcare organization must follow.

Tip No. 1: Registration

When there is a high volume of claim denial, any healthcare office staff can feel overwhelmed. Now, the biggest reason why there are so many denials is that the representative trying to collect insurance data from patients is failing to collect adequate and accurate data. This is the most common problem with every healthcare organization- collecting incomplete, incorrect, and insufficient data from the patients. To avoid claim denials, give proper training to your call-center staff who collect patient’s insurance information. They must understand the importance of collecting accurate data and the repercussions a healthcare industry can suffer if they fail to do so.

At least one week prior to the appointment, the healthcare organization should ask their financial clearance team to check on the scheduled encounters and verify all the insurance. While going for a face-to-face registration, make sure to check insurance cards, along with the expired patient identification. These are just some checklists that one must follow. Ten minutes spent on the starting phase of the registration will help you eliminate the challenges.

Tip No. 2: Copay Collection

If your healthcare systems have multiple branches or clinics in different regions, having consistency with copay collection should be a priority because one might lose traction. To avoid follow this:

  • Try to create an easy-to-understand reference sheet.
  • Feed it with standardized documentation.
  • Ensure it encompasses the correct copay workflow.

Since there are multiple branches, you need to create a system through which you will be able to share your monthly copay collection rate report per clinic location.

Tip No. 3: Charge Capture and Coding

One of the highly crucial things for any healthcare organization is to implement and develop a charge capture process that will effectively capture revenues for every service that the patients have taken. One of the most common areas that often suffer or get neglected is outpatient nursing procedures, such as injections and IV therapy. This happens when there is a lack of proper nursing documentation training. Even pharmacy revenue can be lost too when you miss charges or there are some errors in the reporting units.

It is crucial for both the pharmacy and nursing team to take a good look at their review chart and understand which charges have been missed and why. They are an essential part of the healthcare systems, and they must submit correct documents. If it is a nursing document, then it must include the start and stop time, drugs used, and any other information, which they feel is necessary. For pharmacies, they must report dispensing units properly.

Along with this, coding errors, such as upcoding or down coding could be hurting the healthcare revenue cycle as well. Both procedure and diagnosis codes need to be updated annually, and taking training on ICD-10 coding could help reduce coding errors. It is a known fact that entering an invalid code will make a claim be rejected. The best way to resolve coding errors is to stay updated with the latest version of coding books. While setting up the RCM system, implanting the coding function to rule out all the possible errors is important.

Tip No. 4: Timely File Claims

Always file claims promptly. If the healthcare organization fails to do so, they will miss out on the deadlines. When deadlines aren’t met, the claims that you have received will, unfortunately, go unpaid. This means that one needs to write off clinical services that have been rendered. Give proper training to the claim department if you have, and try to explain the importance of sticking to the deadline. Missing out on deadlines will lead to challenges; hence, always file claims on time.

Tip No. 5: Customer Satisfaction

A good healthcare revenue cycle management team must think of the best ways to keep their customers happy and satisfied. Some of the things that one must take into account are- how much time has been taken for the claim process to initiate, how about denial management, AR caller’s ability, how does one deal with patients when they are resubmitting claims or appeals for a claim, and how about the security of patient’s data.

To maintain a streamlined healthcare revenue cycle management, make sure to offer the exceptional utility of services.

Wrapping up

Remember the challenges that you can face, and try to overcome them with strategic planning. These five tips will help you manage a good healthcare revenue cycle management. If you want to know more about healthcare revenue cycle management, do contact Unify Healthcare.

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