Revenue cycle management (RCM) is the financial process, utilizing medical billing software, that healthcare facilities use to track patient care from intake to the final payment of a balance.

In this chapter, you’ll learn about how RCM is essential in healthcare, its purpose and strategies you can use to optimize your patient revenue recovery.

Why Is Patient Revenue Recovery Essential in Healthcare?

Patient revenue recovery focuses on collecting balances from self-pay patients and from patients who have a balance after insurance has been applied. A strategic patient RCM strategy helps providers collect patient payments.

Many of the challenges of collecting patient payments stem from common underlying issues:

• Inadequate staffing: Many healthcare organizations do not have the back-office personnel to handle the high volume of accounts receivable they must process. Without time, resources or personnel to process accounts promptly or address delinquent ones, these can hinder your patient payment collections.
• Tight submission deadlines: Payers often have tight submission deadlines and zero tolerance for coding errors. However, manual processes in hospital accounting departments are often not efficient enough. Digital patient intake and insurance verification reduce the manual processes that lead to a high number of claims denials and missed deadlines that disrupt cash flow.
• Lack of sufficient tools: Many healthcare accounting teams do not have the tools or analytics solutions for effective revenue recovery. This issue often stems from the misconception that implementing artificial intelligence (AI) comes at a high cost. However, 62% of healthcare analytics decision-makers find that implementing these technologies can produce a strong return on investment and make an overall positive impact on organizations.

What Is the Purpose of Revenue Cycle Management?

Revenue cycle management is a function in all healthcare practices. It unifies the business and clinical sides of healthcare by linking administrative data — including patient information and insurance providers — with the treatments that patient receives and their healthcare data. Communicating with healthcare insurance companies is a key aspect of RCM.

Here is what’s involved in the revenue cycle:

• Renders medical services into billable charges
• Submits claims of billable fees to insurance companies
• Provides proper coding diagnoses and procedures
• Determines patient balances and collects payments
• Collects patient preregistration information
• Collects patient information to establish a medical record number
• Collects payments from third-party insurers
• Examines the necessity of medical services

A strong revenue recovery strategy can help identify denied or underpaid patient accounts, prevent discrepancies in interpreting contract terms by payer and provider, and identify errors made by payers in calculating the allowed amount. All of these functions aim to optimize a healthcare organization’s revenue stream and ensure financial viability.

5 Patient Revenue Recovery Strategies

You can boost patient revenue recovery in various ways, including:

1. Verify Insurance Information

There is a significant deal of uncertainty at the private practice level in matching patients to insurance coverage. As patients get older and become Medicare-eligible, they may change jobs and healthcare coverage. They might also not have coverage between policy changes. Any of these challenges can create an administrative problem for medical clinic staff as they attempt to verify insurance coverage and collect copayments at the time of service.

By implementing technology-enabled tools or software, you can efficiently verify your patients’ coverage, benefits and reliability. This approach will boost your revenue recovery, allowing for pre-authorization management and helping your administrative team be more knowledgeable at check-in by electronically confirming a patient’s eligibility and claim status.

2. Address Denied Claims Efficiently

It’s crucial to swiftly address claim denials. You’ll need to identify denial patterns, address root causes and implement corrective actions to support your revenue recovery efforts.

A patient portal that verifies insurance eligibility will submit better claims from the beginning, allowing your staff to efficiently address common denial reasons, such as missing or incomplete supporting documentation. Working on denied claims efficiently will help keep cash flow moving.

3. Use Digital Patient Engagement Tools

You can reduce billing disputes by maintaining effective communication with patients. Be transparent about costs, benefits coverage and payment plans, which can enhance patient satisfaction and reduce potential revenue loss. Use digital patient engagement tools, such as patient intake and insurance eligibility verification technology, to allow patients to update insurance and other critical information before their appointment.

These tools can verify that the provider is in their coverage network and determine the patient’s responsibility. When the patient arrives for their appointment, they’ll be better prepared to pay their copay. If there is a claim denial, the provider can simply communicate with the patient through the portal to provide any updated information.

4. Optimize Coding and Documentation

Accurate coding and billing are at the core of revenue recovery. You’ll need to ensure your procedures, diagnoses and services are correctly coded to prevent denials and accelerate reimbursements. You can do this by investing in training resources for coding staff and using technology, such as computer-assisted coding systems. These tools can assist in accurate coding, reducing errors and increasing the accuracy of your claims to improve reimbursement rates.

Keeping your team updated with the latest industry trends and coding guidelines is essential. An informed team will find revenue recovery opportunities ahead of time and prevent future errors. Fostering a culture of vigilance and feedback can ensure revenue recovery becomes an intrinsic part of your organization.

5. Analyze Revenue Cycle Data

Healthcare organizations can use technology to analyze revenue cycle data. The right software can provide holistic insights into your organization’s financial health by:

• Identifying trends
• Monitoring key performance indicators (KPIs)
• Tracking accounts receivable
• Generating insights to optimize revenue recovery strategies

Regularly analyzing your data boosts revenue recovery efforts as it helps you proactively address leakage and streamline processes.

Increase Your Patient Revenue With Millennia

Healthcare revenue recovery is a crucial aspect of the industry. Having a strategic revenue cycle management strategy can prevent coding errors, insurance discrepancies and other complex procedures from impacting your bottom line. Millennia develops tools for hospitals and health systems that allow you to engage patients and recover revenue faster and more easily.

With our end-to-end solution, you can improve your patient payment experience, reduce administrative costs and gain valuable insights through reporting capabilities. Schedule a consultation to learn more about collecting patient payments.