To optimize your revenue cycle processes, you’ll first need to understand the factors that impact it most. Medical coding and billing, patient demographics and volume, and provider productivity are factors to be aware of when optimizing your RCM. From there, you can focus on interoperability, problem analyses, customizing technology and implementing staff training to enhance RCM strategies.
In this chapter, we’ll provide a breakdown of the factors involved in RCM and how to optimize your approach.
Factors that impact hospital revenue cycle management include:
Inaccuracies in your patient demographic or insurance data can lead to various issues, from denials to unnecessary follow-ups. This crucial feature of RCM can be altered by entering patient data into the wrong medical record, mistyping an address or choosing the incorrect insurance.
Coding is another significant factor in RCM health. You can correct any medical coding errors by integrating a review and audit process. EHRs can also track your patient data and ensure coding and billing requirements are correct.
Medical billing is a complex factor that can impact your revenue cycle. By implementing systems training, you can streamline your billing systems and improve order entry for the health of your organization’s RCM.
While patient volume is an internal revenue driver within your control, it can be challenging to optimize since the nature of most medical practice services lends to lengthy payment cycles. Most bills go from the payer to the practice to the patient over many months, if not longer, before being collected or written off.
Productivity is another internal revenue driver that you might optimize for your RCM strategy. By utilizing automation tools, you can lessen the workload on individual staff members so they can focus more on delivering quality patient care.
Collecting accurate details for payments is a crucial feature of RCM. Mistyping or missing a digit altogether can mean stopping the claims processing in its tracks.
You’ll need accurate details from each patient to be able to submit claims and receive timely reimbursement. Ensure billing and coding details are as accurate as possible to improve your revenue cycle health.
Remittance is another factor involved in RCM, referring to the handling and settling of payment information received from insurance companies. It’s a crucial component of RCM, as you need it to accurately record and reconcile payments, track your revenue and maintain financial records. Effectively managing this process can help streamline your RCM strategies and maximize revenue collection.
Following remittance, you’ll need to collect payments from third-party insurers. The process can optimize your revenue generation by ensuring accurate claim submission, prompt reconciliation and handling of any denials. It also promotes effective patient balance collection so you can maintain a healthy revenue cycle.
Examining the necessity of medical services is another component of RCM. It ensures you comply with insurance criteria to prevent fraud, meet regulatory guidelines, mitigate risks, maximize your reimbursements and ensure patient-centered care.
Here’s how your organization can improve its revenue cycle management:
It’s crucial to collect all insurance information from your patient at the time they first seek care, or even before they arrive for an appointment. Building that foundation is important for the claims you end up processing and dictates how you collect payments from the patient or make arrangements for the balance due. Effective communication can ensure patients know their benefits ahead of time.
Interoperability in healthcare refers to the ability of various healthcare systems, devices, software applications and networks to exchange and use patient health information. Healthcare data interoperability plays a crucial role in care delivery, patient outcomes and data management. Technology can eliminate manual processes and reduce labor costs, making it important to recognize the feasibility of integrating each of your individual software applications.
It’s best practice to conduct a business problem analysis to optimize your revenue cycle. While tools, technologies and techniques can help, you should have a clear picture of why it’s important or necessary to enhance your RCM. For some people, optimization might look like incremental improvements in an already high-performing revenue cycle. For others, it might be automating most of the revenue cycle within the next five years.
In either scenario, invest in business problem analysis, user stories and use cases. Think about your goals and optimize your RCM accordingly. Choose a why-based vision statement that is specific, realistic and measurable. From there, you can outline your technology requirements, people requirements and a roadmap for execution.
As the healthcare industry shifts, many organizations will maximize technology, using digital portals and telehealth. To achieve this, clinical and revenue cycle workflows must be better connected.
A best practice involves looking at your long-term RCM products and solutions and optimizing your spending. You might invest in vendors that offer a suite of products that work seamlessly together, helping your data flow easier from workflow to workflow.
Another tip to optimize RCM is customizing technology. With various applications and payer portals, you’ll want to ensure they have a consistent user interface. A white-labeled patient payment portal gives your patient a consistent digital journey to make submitting payment even easier.
Healthcare changes quickly, making it crucial to implement staff development programs where employees can learn coding and billing techniques, revenue cycle best practices and health insurance fundamentals to better educate patients. A well-informed team will proactively prevent errors and identify revenue recovery opportunities at every turn.
It’s crucial to understand the facets of RCM and how certain changes can impact your overall financial stability and revenue recovery. At Millennia, our Mobile Pay feature can help you streamline your revenue recovery processes and enhance overall financial management. Schedule a consultation to learn more about patient revenue cycle management and our revenue cycle management solution.
