Healthcare RCM and What it Means for Your Hospital Revenue Management Systems

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When it comes to your patients, the focus is on the continuum of care. But when it comes to the business of practice management, your focus should be on the continuum of revenue. In this blog, we examine the importance of a stable revenue management system: workflow automation, patient pay, insurance verification, preauthorization, coding, and billing.

The main question any healthcare organization should ask itself is whether it has one continuous process in place that connects patient scheduling to successful claims. Depending upon the systems integrated into practice workflow, the process is either a rock solid highway to revenue or a shaky rope bridge with gaping holes through which revenue is lost. Only one will serve your practice well.

Streamlined systems improve cash flow

The foundation of all excellent revenue generating systems is workflow automation software. When one solution and one platform is in place, workflow is streamlined and cash flow will follow. The system reduces claim rejection, speeds preauthorizations and reduces staff time. Secure, HIPAA-compliant cloud data storage and electronic documents should interface data seamlessly across RCM and EHR platforms. When a system like that is behind your practice, complete, timely, successful claims and revenue are the result.

A revenue process that leads to high performance

Highly functioning components make up the best revenue cycle management systems. When you assess the capabilities of your current backend functions, determine whether it includes the following elements that create efficiencies and economy of scale. If you are experiencing lost revenue, it may be due to the lack of one of these revenue linchpins.

Patient pay: The patient pay process should begin when the appointment is scheduled. Patient pay makes up 30 percent of accounts receivables for physician practices — that’s why it matters. Patients need to fully understand their payment responsibility and be prepared to pay at the time of visit. A good process sets that in motion. Statistics show that 90 percent of patients are likely to pay before they see the physician but only 40 percent will pay after they leave the practice.

Insurance Verification: Do you verify insurance at the time of scheduling? That’s the optimal time because it puts in motion a discovery process for your staff and education for your patient. It saves time, money, and the scramble for information when your patient appears at the door of your practice. You need coverage details, network information and details on deductibles to inform your patient and prepare for accurate and timely patient pay.

Preauthorization: Know the details of each patient’s coverage before tests need to be ordered. Your physicians may have to act fast, and all staff should be ready to respond. Preauthorizations can interrupt patient care if your system doesn’t prompt staff to handle it in advance. Better information leads to more revenue.

Coding: There is no way around it, coding is complex. The intricacies and nuances of coding can make or break the success of claims. In the wake of ICD-10 and the tripling of alpha-numeric codes, coding isn’t for the lighthearted or the inexperienced. The right coding has the power to reduce denials.

Billing: It’s so much more than paperwork; billing is the lifeblood of practice revenue. When you review your billing function, look at these factors and gauge their efficiency.

  • Charge entry should post patient demographic data, medical codes, and insurance information.
  • Payment posting should be regular and staff should be proportionate to the number of providers in the practice.
  • Accounts receivable days should be firmly in control to maximize revenue with timely payment posting and accurate aging reports.
  • Denials management should wring every dollar out of every denial with timely appeals. (Fifty to 60 percent of denials go unworked.)
  • Credit balances are regulated by law. Ensure you are in compliance with balance resolution and 3rd party overpayments. If not, you may pay hefty fines to payors.
  • Contract management — the bottom line are you getting paid your contracted amount, every time?

Review your RCM process

Luckily the continuum of revenue isn’t a mystery; it’s a precise equation of well-oiled functions. Assess your process and if you find gaps and inefficiencies call in experts to repair them. If you don’t have an efficient process in place to ensure your patient scheduling leads to reimbursements, that’s the very place to start.

Examine your entire revenue cycle management process: workflow automation, patient pay, insurance verification, preauthorization, coding, and billing. Everything needs to add up to a well-oiled system that tracks patients and care received to billing, denials management, and resubmissions. The work you put in will pay off in spades.

InfinxHealthcare RCM and What it Means for Your Hospital Revenue Management Systems

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