Every business needs revenue to survive, and medical practices are no different. Revenue cycle management in healthcare is considerably more complex than other industries, especially in these uncertain economic times. Healthcare costs are rising, a recession is looming and practices are facing challenges with reimbursement. Read on to learn what your practice can do to streamline this process and improve your revenue collection efforts.
Technology’s role in revenue cycle management
The healthcare RCM process uses medical billing software to complete the clinical and administrative tasks necessary for claims processing, payment, and revenue generation. Today’s technology provides automation and advanced tools for managing the revenue cycle. Typically, this process will include at least the following four steps:
- Coding: Translating the services rendered as detailed in documentation into billing codes.
- Charge Capture: Translating those codes to billable charges.
- Claims: Submitting reimbursement claims to payers.
- Collections: Pursuing patient payments for remaining balances.
To put it even more simply, all of the tasks that lead to a practice receiving payment for services are essentially a part of the RCM process.
Why is RCM in healthcare important?
No practice can survive without revenue, so the RCM process is crucial to keeping practices in business so that they are able to provide patient care. This process can be complex, and if it isn’t well-managed it can lead to costly delays in payment. However, an efficient RCM process keeps a practice financially stable by maximizing revenue and minimizing errors, enabling the staff to maintain their focus on providing quality care.
5 Best Practices for RCM
- Provide transparency and convenience for patients. Patient cost estimation tools can help clearly communicate, both verbally and in writing, what a patient’s responsibility will be, when their payments are due, what their payment options are, and anything else they can expect. Ideally, you’ll want to collect the patient’s financial responsibility at time of service, but make sure that patients are prepared for this ahead of time. Also, allow convenient options for patient payments such as online or mobile payments, and have payment plans available for patients who need it. All of this will reduce surprise bills and unpaid balances.
- Invest in advanced billing technology. Choose a system that automates revenue cycle management and streamlines the process of checking eligibility, receiving prior authorization, coding, and billing. Your software should also alert you to errors prior to claims being submitted, so you can resolve issues before a claim is denied.
- Ensure thorough documentation for accurate coding and charge capture. Make sure that everyone on staff understands the importance of accurately documenting each encounter as this is where the information for your coders comes from. If it isn’t documented, it can’t be coded, so make sure to be thorough.
- File claims in a timely manner and be vigilant to manage denials. There are deadlines for when practices must file claims, and often these deadlines vary from payer to payer. Be aware of what the requirements are and be careful not to miss your submission window. Also, while it’s best to work hard to prevent denials in the first place, you will likely still see a few from time to time. Make sure you have an efficient process in place to correct, monitor, and track both line level denials and claim denials, as well as technology to catch underpayments, to ensure you receive optimal reimbursement.
- Use reporting and data analytics to track and improve your practice’s RCM process. Focus on revenue integrity to maximize reimbursement by leveraging technology to identify gaps in payments or underpayments. Be sure to choose billing software with robust reporting capabilities so that you’re able to pull necessary data and gain insights into where your practice’s RCM process is succeeding and where there’s room for improvement.
An efficient RCM process is crucial to the financial health of your practice. Without adequate revenue, providing quality patient care becomes difficult, if not impossible. This is why MicroMD Practice Management is designed to streamline your practice’s RCM process from start to finish. Additionally, our Solutions Center is full of best-in-class vendors to further improve your organization’s revenue cycle management.
For more information about MicroMD Practice Management RCM tools or if you are a MicroMD customer interested in upgrading your RCM technology solutions to work smarter, visit micromd.com or call 1-800-624-8832.
About the author,
Adrienne Sender leads content creation activities at TriZetto Provider Solutions, a Cognizant Company. Well versed in Revenue Cycle Management, she creates case studies, whitepapers, articles and more to grow the brand and position it as a thought leader in the healthcare space.
About the author,
Crystal is a Digital Marketing Specialist at Henry Schein MicroMD. Content creation, social media management, and SEO optimization are just a few of her areas of concentration as she seeks to educate clients and prospects alike about the simple, customizable, and connected solutions we offer at MicroMD.