9 best practices to have a successful healthcare revenue cycle management

Revenue collection for the Physician’s practices depends entirely on revenue cycle management; therefore, it is the most crucial aspect of the healthcare system. It is critical for healthcare businesses to maintain their overall financial health by overcoming the challenges in procedural coding implications with streamlined billing and revenue collection workflow process. Some of the most common challenges every organization faces in RCM are:

• Data entry errors in patient registration.
• Collecting payments promptly.
• Lacking deep insight into the revenue cycle.
• Dealing with excessive coding errors because of improper medical coding practice.

How to improve revenue cycle management-(9 actionable ways)?

Most healthcare facilities face the same issues in various specializations, which could be overcome with effective troubleshooting techniques. Here are five tried and accurate methods for increasing RCM output:

Maintain your RCM workforce proficiency

Collecting incorrect, incomplete, and insufficient patient data is the most common problem with every healthcare organization, which causes repetitive denials from the Payers. The legal authorities of your organization need to train your patient help desk staff, who is responsible for the patient’s insurance information collection. Concerned professionals in your CRM must understand the consequences an organization can face if it fails to maintain accuracy in patient insurance information collection.

Prior insurance verification

Validation of the EOB (explanation of benefits) is essential during patient registration while integrating RCM into medical practices. Your organization’s financial clearance workforce must perform the insurance verification process for the scheduled encounters at least one week before the appointment. Insurance cards and expired patient identification must be checked while going for in-person registration.

Automate your EOB processing

Entering explanations of benefits manually into their patient accounting system causes various issues and hidden costs. First and foremost, in manually processing, every Payer’s EOB has a learning curve because each has its format and terminology; secondly, It is challenging to locate and extract such a large amount of EOB data that is required to keep your business moving ahead.

Streamline your EOB validation process using healthcare technology that will automatically extract all the data required from your paper EOBs and deliver them to your patient accounting system, including patient names, account numbers, service dates, procedure codes, line-item details, individual claim amounts, EOB totals and much more. Software tackles the hidden cost that inflates expenses and slows productivity by automating EOB processing.
Following are the issues include:

• Keying data manually into patient accounting systems.
• Validating that procedural charges claim totals and EOB totals are in balance.
• Reviewing EOBs manually to investigate and resolve patient claim discrepancies and denials.
• Missing out on secondary billing opportunities.
• Enforcing patient privacy compliance (HIPAA).
• Managing incoming cash flow to recognize revenue as soon as possible.
• Accommodating growing workloads while controlling costs.

Consistent copay collection

If you have clinics in multiple locations, it is critical for your healthcare system to have consistent copay collection; instead, you will be at risk of losing customers. Follow these guidelines to overcome the risk:

• Make a reference sheet that is simple to understand.
• Feed it with standardized documentation.
• Make sure it follows the proper copay procedure.
• For instant collection, the best time to collect patient balances is during the check-in or check-out process when the patient is in front of you.

You must create an efficient system to share your monthly copay collection rate report for your clinic branches.

Streamline your charge capture and coding process

It is crucial for any healthcare organization to build an efficient process to capture revenues for every service that the patients have taken productively.
Your organization’s financial health is directly dependent on the process your administration follows to capture the charges for the Physician’s rendered services. Your approach must be comprised of proper utilization of charge information, processes, and systems and should have the following characteristics:

• Your nursing staff must emphasize the administrative responsibilities equally to the caring patient.
• Your process must assist your workforce in capturing and posting charges for the rendered services promptly with high accuracy.
• Your workforce concerned with charge capturing and posting must be accountable for their assigned responsibilities.
• Your organization must consistently monitor your staff’s performance to follow standard policies and procedures.

Outpatient nursing treatments, such as injections and IV therapy, are among the most prevalent areas that suffer or are neglected. When there is a lack of sufficient nursing documentation training, this occurs. Even pharmacy revenue can be lost when you overlook charges or make errors in the reporting units.

Filing claims promptly

Give your department proper training to process claims in compliance with regulatory authorities, assure them how crucial it is to meet the deadlines of the provider’s Payer, and what challenges you need to face from the insurance company and provider in missing out on deadlines. When the providers don’t file claims promptly, they will miss deadlines.

Most insurance companies permit only one year to file claims from the date provider has rendered service, but many private insurance companies only allow 90 days. Your organization must ensure to file claims promptly; instead, if the deadlines are not met, that will force the practice to write off healthcare services.

Implement a denial prevention program

Your organization must implement a denial prevention program for your administrative workforce that focuses on a standardized process to reduce denial risk. Your system must be proficient in monitoring and tracking denials for the medical practices to identify trends and discover their root causes. Best practice denial management programs can reduce A/R, increase cash flow, decrease denials volume, and lower the cost to collect rate.

Constantly track financial health performance

Regularly analyzing your practice financials with the key performance indicators is highly recommended. It would let you determine the root cause of the revenue leakage in your practice, which you can solve to maximize and maintain consistent cash flow.

Net Collection Rate Analysis would provide insights into the revenue lost because of the factors such as payable debts and delays in claim filing. Accounts Receivable Analysis allows you to calculate the percentage of AR over 90 days and determine the entity that includes a patient problem, an insurance problem, or both that cause pain. Charge posting and a billing log analysis will allow you to track how long it takes your biller the claim to the Payer.

Here are some of the key performance indicators that your practice must consider:

Your practice must stick to the HIPAA standards

Your clinical practices must adhere to the HIPAA standards to protect patient medical records privacy, security, and confidentiality. According to HIPAA regulations, all healthcare providers must submit clean claims electronically in a standard format for managing the revenue cycle in medical billing, preventing errors, and maximizing accuracy.

How MedsIT Nexus can help you streamline RCM?

MedsIT Nexus medical billing and coding services comprise a streamlined revenue cycle workflow process, adhering to discussed best practices. Our RCM professionals utilize healthcare procedural coding software to maximize your clinical financial health. Therefore our services guarantee to maximize your revenue collection by up to 30%.