How Can an Organization Improve Its Revenue Cycle Management (RCM)

Are you interested in saving money? Or, better yet, are you interested in making money? In today’s healthcare landscape, where every dollar counts and compliance is non-negotiable, mastering your revenue cycle is not just a choice; it’s a prescription for success. But how can an organization improve its revenue cycle management?

Revenue cycle management (RCM) is the financial lifeblood of any healthcare organization, simplifying the complex process of getting paid for medical services. It encompasses everything from patient registration and appointment scheduling to insurance claims, billing, and payment collection.

Effective RCM ensures that healthcare providers are accurately reimbursed for their services, all while delivering a seamless and transparent experience to patients. By optimizing RCM, healthcare organizations can maintain a healthy cash flow, reduce claim denials, and allocate more resources to delivering high-quality patient care.

Revenue cycle management faces several common challenges in the healthcare industry. These include complex medical coding and billing processes, frequent changes in healthcare regulations, and the risk of claim denials due to errors or lack of insurance coverage.

Patient billing can be challenging, no-shows and late payments from patients impact revenue, denied claims slow the process, and rising costs of healthcare eat into the profits. Your organization must navigate these challenges to maintain financial stability and deliver quality care to patients.

How Can an Organization Improve its Revenue Cycle Management?

Improving revenue cycle management is essential because it directly impacts a healthcare organization’s financial health and, in turn, its ability to provide quality patient care. Efficient RCM ensures that healthcare providers receive timely and accurate payments for their services, helping to maintain a steady cash flow.

This allows organizations to invest in better equipment, hire skilled staff, and offer advanced treatments. It also reduces the risk of claim denials and costly billing errors, saving both time and money. By improving your RCM, you can allocate more resources to the whole reason you got into medicine in the first place: the patients.

RCM System Software

Streamlining the patient registration and insurance verification process for both your staff members and the patient will make it easier to get accurate and complete personal information and medical history. This could include online forms and appointment scheduling, automating the process for your front office crew.

Verifying insurance eligibility and information before any visit, care, or procedure will help cut down miscommunication between you, the patient, and the insurance company, cutting down claim denials and missed payments. Getting as much information as possible at the start will make things much easier–and accurate–in the future.

Staying up to date on the latest RCM software is one of the easiest ways to improve your RCM. If you want to handle RCM in-house, then management software can be your most valuable resource. It will help you track your revenue, your outstanding requests from insurance companies, your patient’s records, and many other features.

In addition, it can provide assistance for what you may need to do in certain situations. By automating tasks such as claims submission, denial management, and follow-ups, you can free yourself and your staff to provide better customer service and ensure patients get the best care.

Revenue Cycle Management Staff Training

Anyone in the medical field has already gone through years of intense education to become the professionals they are today. Part of improving the process is making sure your staff is equipped to keep up with the multitude of changes to the healthcare system. Provide employees with the training and resources they need to be successful.

However, running a successful business requires more than just a medical degree. In particular, it requires knowing tax laws, issues with compliance, and a good understanding of revenue cycle management. To solve this, we recommend taking a course on RCM to better understand what’s required of it. This coursework will reveal areas where you can improve your medical practice’s financial standing.

Have a Process for Denials

With the transition to ICD–11, it has never been more important to take both compliance and denials seriously. For improving your revenue cycle, understanding compliance will take some time, but it will reduce the headaches you have to deal with down the road. Staying updated on medical coding changes is crucial for effective revenue cycle management.

These changes reflect the evolving landscape of healthcare, including new treatments, procedures, and diagnoses. Keeping pace with these updates ensures that billing, coding, and claims processing remain accurate and compliant with industry standards and regulations. Failure to do so can result in claim denials, delayed payments, and even legal issues.

Keep these two things in mind: more than 50 percent of appealed denials get paid, and it is always worth fighting for every claim made against the insurance provider. If you hire someone specifically for accounts receivable, you can have the revenue they generate to pay for their work.

Denial Review Process

Carefully review the denial notice from the insurance company to understand the reason for the denial. It may cite a coding error, lack of medical necessity, or other issues. If needed, reach out for clarification and additional information regarding the denial. If the denial resulted from a coding or billing error on your end, correct the error and resubmit the claim with the accurate information.

And if you believe the denial is incorrect, you have the right to appeal it. Follow the insurance company’s appeal process, which typically involves submitting a written appeal with supporting documentation. While every company is different in some way, make sure to include medical records and a letter explaining why the claim should be paid.

Remember that claim denials can be common in the healthcare industry, but with persistence, accurate documentation, and a good understanding of the appeals process, many denials can be successfully overturned, allowing your healthcare organization to receive the reimbursement it deserves. Sometimes, that will fall on the patient.

A Plan For Patient Payment

The most effective way to secure payment from a past-due patient is to establish clear and respectful communication. Start by sending polite and informative reminders about the unpaid balance, preferably in writing. If there’s still no response, follow up with a phone call, and offer flexible payment options or plans to make it easier for the patient to settle the debt.

If necessary, consider involving a collections agency, but always prioritize understanding the patient’s circumstances and working together to find a solution. Maintaining a patient-centered approach and open lines of communication can often lead to a mutually satisfactory resolution and the payment you’re owed.

Consider Outsourcing to Improve Revenue Cycle Management

A medical billing company works on an economy of scale, where their services become inexpensive due to the sheer volume of work they do. When done correctly, they will pay for themselves (and possibly more). They will have experienced technicians who know how to approach denials as well as experts you can speak with to improve your RCM.

While you will have to pay for the services, you will gain much in the amount of time and energy saved by outsourcing. For handling healthcare revenue cycle management, the most valuable resources are time and experience. If your practice has opened somewhat recently, or if you don’t have the time to handle RCM properly, then it’s best to look into hiring an outside company.

Use MBA Medical Billing to Help

At MBA Medical, our skilled team is here to manage your revenue cycle management needs, whether it’s the whole process or just parts of it. We’ve adapted to the changes in the healthcare industry and provide a variety of solutions to support our clients at every stage. Our team regularly trains in top-notch practices to enhance our business management services.

You chose a healthcare career to care for people, not to deal with payment hassles or insurance headaches. If you want to concentrate on providing great care, MBA Medical is here to make sure your revenue cycle management goes smoothly. Give us a call today! With more than 25 years of experience, we’re handling millions in revenue a month for hundreds of clients. We’re ready to answer your questions or meet with you to understand your specific revenue management needs.