What Should I Look For in a Revenue Cycle Management Solution?

Posted by KUNAL JAIN on Mar 9 2015

Fotolia_72284866_Subscription_Monthly_M-370547-editedOn top of the difficult transition to ICD-10, healthcare providers are being pressured to adjust to a multitude of changes alongside the industry. This includes optimizing their Revenue Cycle Management, or RCM.

Implementing cost-effective strategy solutions in conjunction with doctor-patient relationships is equally imperative. In fact, both must work in tandem with one another in order to run a practice that is successful and lucrative. You may be the best doctor in the world, but without the ability to process payments and utilize an EHR, your practice won’t remain open for long in these times.

You are probably wondering how to improve your practice’s RCM, whether you’re an office manager or a doctor. There are several things you should seek to achieve an ultimate RCM solution. They are as follows:

Know your Practice’s Financial Policy

Make sure all providers and staff are knowledgeable of the practice’s financial policy, as this covers co-payments, patient responsibilities for insurance, and plans for self-pay and all other guidelines your practice has set. By training your staff and front desk well, you are equipping yourself in the battle to getting paid.

As you know, the revenue cycle is the moment an appointment is scheduled with a patient to the moment their bill is paid off in full. A patient may talk to multiple members of your staff, so make sure they are all on the same page so information doesn’t get muddled or misconstrued. It’s small discrepancies like this that can cost your office money.

Register your Patients Properly

Once you register a patient, make sure all their information is present, including their insurance carrier and other demographics necessary. Seek more organization by keeping a check list or document to follow every time a new patient comes into your office. Don’t take shortcuts in this juncture, or you may find errors later that can be costly and delay claims.

If any pre-authorization is required, delegate specific staff members to give proper attention to the forms and information presented. Do they have Medicare, and need additional documentation to be sent in advance? These are all things to consider, as every patient is different and their insurance companies require different things.

Charge Entry

Capturing charges means gathering all of the necessary medical information for use in a medical claim document. This avoids billing something incorrectly or not having sufficient information for a claim.

You should look for this: do your EHRs transfer automatically to your practice management system, or do you have to manually input information? Having to manually go from paper to electronic is a thing of the past, as this slows down the efficiency of a practice—otherwise, you are losing revenue.

The ultimate goal to look for here is to keep the amount of claims that are denied on first submission to a minimum, and to eventually be paid in full for each claim. This will allow your RCM to be more accurate and flow better overall.

Denial Management

Depending on the size of your practice, you may want to delegate denials to one person’s job entirely. Why, you may ask? Denials mean your office isn’t getting paid, and the sooner the issue is figured out (whether it’s incomplete information, codes, or otherwise), the sooner you can be paid.

Every provider has different specifications for appealing denials, so make sure your denial management employee stays on-top of these parameters and maintains a close relationship with these representatives. Learning the trends of what paperwork is being denied and amending those mistakes will also save time and efforts in the future so they won’t keep popping up.

Maintain a Consistent Billing Schedule

By sending your bill to the patient sooner rather than later, you will get paid faster! Place patients on a weekly statement system that will allow billing to go out consistently so you and your staff aren’t overwhelmed when you set a “due date” for multiple patients all in the same week.

This is, of course, much easier to attain if you outsource your billing. By doing so, you allow your staff to focus on the patients’ care and follow-up.

Conclusion

These are just a few things to look for that can enhance your RCM and develop an ultimate solution to all of your billing needs, from appointment in to pay-out.

Still have questions? Feel free to check out more about outsourcing your medical billing and how it can benefit your practice today!

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Topics: Revenue Cycle Management

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