Revenue cycle management processes are designed to ensure providers receive accurate payment for the services they provide their patients. Because most of that revenue is driven by insurance and government payers, RCM operations are structured around payer-provider communications and interactions, and to a much smaller degree, provider-patient interactions for copays and deductibles for insured patients and upfront payments for true self-pay patients. 

In today’s healthcare environment, the patient portion of a provider’s revenue is increasing, and yet, RCM processes have not adjusted to meet the challenges of collecting post-adjudication payments from patients. As high deductible health plans (HDHPs) become more prevalent, it’s critical for providers in both outpatient and inpatient settings to refine their approach to RCM and adopt processes specific to the patient revenue cycle.

To address the challenges of the patient revenue cycle, and in turn, to improve revenue collection from patients, providers must address these “blind spots” in their revenue cycle:

• Post-adjudication balances are going uncollected: Most EMRs only report a single data point for patient revenue and do not differentiate between patient prepayments and post-adjudication balances. This can lead to a false sense of security about patient revenue collection rates. A practice that is very good at collecting upfront payments may seem to have a high collection rate. However, post-adjudicated balances are a smaller percentage of overall patient revenue, so the high pre-visit collection rate may hide the fact that the post-adjudication rate is very low, and too much revenue is going to bad debt. 
• Patients are consumers, with consumer expectations: While providers have a more personal relationship with their patients, its important to remember patients are consumers, with expectations that they will have the same options for payment and communications channels available in retail transactions, including both digital and high touch personal service when they have questions.
• Patient portals are not for everyone: Its understandable that providers, who have made significant investments in their EMR, want all their patients to use the patient portal to pay their bills. But study after study has shown that portal adoption hovers around 50-60%, with only a small portion of patients using the portal for payment. Providers need to think outside the EMR to drive more revenue.  

Start By Mapping The Patient Financial Journey

We can all agree that the healthcare revenue cycle starts as soon as the patient makes their first appointment. But it should not end with sending bills to collections and an eventual write off. From patient intake to final payment, a patient revenue cycle ensures patients understand their financial responsibility and are able to easily pay their bills. 

Next, Design A Patient-Centric RCM Process

Whether you run patient RCM operations in-house or choose to partner with a patient RCM vendor like Millennia, certain functionality is critical to the success and efficiency of your patient revenue collections. 

1. Digitize Patient Intake: Give patients the ability to complete their forms online, before arriving in your waiting room. They can fill them out at home, where they have easy access to the information they need (i.e., insurance information, prescriptions, notes from prior encounters). 
2. Automate Insurance Eligibility: Make it easy to verify coverage that is needed to provide precise estimates of patient financial responsibility. 
3. Collect Pre-Visit Payments: Prepayment and point-of-service payment options are easy for patients and your staff and allow you to collect patient revenue upfront. 
4. Make Statements Patient Friendly: Send statements in the patient’s preferred format (print or statement) and include a clear presentation of charges, payments, and balance; multiple options for making payments; and contact information for patients who want more personalized service. 
5. Give Patients Digital Payment Options: To meet your patients’ consumer expectations, give them control of how they pay their bills whether they use mobile pay (e.g., ApplePay), text-to-pay, photo capture bill pay, or an online payment portal. 
6. Offer Payment Plans: Giving patients the ability to pay over time when they can’t pay a balance in full is critical to an effective patient revenue cycle.
7. Provide Personal Attention: Understanding medical bills isn’t easy and patients will have questions. Specially trained patient support specialists can provide personalized service that helps patients understand and pay their bills. 

See Better Financial Results and Patient Satisfaction

A patient-focused RCM solution delivers more revenue, reduces cost, increases efficiency and improves patient and staff satisfaction. 

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Guia White

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