What does an optimal revenue cycle management system provide for your practice? In two words… timely reimbursement!
Revenue cycle management (RCM) involves numerous processes and individuals, all (hopefully) working together to ensure that a healthcare provider is adequately and properly reimbursed for services provided. In fact, proper management of the revenue cycle is vital to enhancing revenues received by a healthcare provider or facility. A denied claim or any other type of lost revenue has a detrimental impact on the financial health of any Healthcare Service provider.
In addition to billing processes, the revenue management cycle includes a variety of necessary functions that involve admission, Patient Access Management, proper case management, correct charge captures, accurate health information management, the business office of the healthcare facility, and compliance.
So why aren’t you reaping the benefits of a well-managed cycle? One effective method for the management of revenue cycle is to develop a team of various department members who are involved in the revenue cycle. Careful analysis of revenue cycle indicators can include but is not limited to the:
Organizing documentation collection is a vital component of a smoothly flowing cycle. Delays in one department can create a domino effect that slows down charging, posting, and billing processes that have a direct and very negative impact on timeliness of reimbursement.
Check out the following chart provided as an example of lost/delayed revenues from one hospital:
Bottom line: you can improve your Revenue Cycle Management (RCM) in numerous aspects of your practice: accurate gathering of data (including front-end insurance information), insurance eligibility verification, accurate coding, and taking advantage of automation.
Here’s the thing: if a billing office staff doesn’t have accurate and complete data to work with, it’s obvious that reimbursement will be delayed through claims denials, time spent back-checking, correcting incorrect information, all of which can drag reimbursement into days or even weeks.
What should a medical group, hospital, or an independent practitioner look for in an RCM system? In today’s new healthcare environment, the focus is on long-term chains of care. It is essential that any healthcare provider accurately capture and verify insurance coverage and payment provisions at the onset.
An effective RCM system should also be able to integrate not only care management information but also financial and clinical information at every step of the patient’s care journey.
Another important aspect is predictive modeling, or the ability to identify opportunities that provide more effective and quality care management that can be culled from huge datasets.
Take into consideration both sides of the revenue cycle: the clinical side and the business sign. On the business side, scheduling is the most important aspects of the revenue cycle because if staff fail to properly and accurately capture various forms of information (including adequate insurance) and patient demographics, you already have a glitch at the front end that can effectively throw a wrench into the entire cycle. An effective revenue cycle management system must also be able to work with numerous insurance carriers and be familiar with their Rules and Regulations for Processing Claims.
Today’s technological gadgets provide healthcare providers to integrate data and efficient electronic authentication into medical records systems. As of 2012, at least half a dozen healthcare revenue cycle management platforms have been designed to satisfy new ACA regulations while at the same time effectively processing patients.
Even newer technologies are continually under development to help improve the revenue cycle management process. The more providers know about these systems, the better they can choose the system that works best for their situation or environment.
If you’re failing at revenue cycle management, chances are there’s a glitch in one or more areas of the cycle flow of information. Expertise in data analysis, Denials Management, policy development and review of Outpatient Code Editors (OCEs) and groupers is essential in developing an efficient revenue cycle.
We could delve into greater detail regarding the importance of accurate physician documentation and coding, but that’s another topic entirely. However, the importance of accurate ICD 9/10 and CPT coding is essential in driving reimbursement. However, this information and data is only as complete as physician’s documentation, and is only as accurate as the coder’s translation of that information.
Bottom line – physicians need to provide as much detailed documentation as possible, which is the initiation point of any revenue cycle management process. So how do you improve your revenue cycle management? In today’s ACA environment, it starts with:
If you’re not doing these things, your revenue cycle management is going to suffer for it. In order to improve the flow, utilize electronic claim submission and remittance payment posting which not only saves time but is very effective in following up on overdue balances or outstanding claims. The revenue cycle may also be shortened when patients are given the option of paying their bills online.