Revenue cycle management (RCM) is one of the most complex medical office tasks. There are layers of steps involved in the process and roadblocks may be encountered throughout the entire process. Luckily, there are ways to apply the standard principles of professional RCM to improve your office's ability to get paid in a timely manner.
Related Read: How's Your Revenue Cycle?
Here are five ways to help evaluate your RCM:
- Utilize the Entire Team
Everyone in the practice plays a vital role in the successful submission of insurance claims. The process really starts the moment the patient calls the office. Obtaining the patient information, processing insurance cards and documenting all necessary information can and should be performed before the medical professionals even see the patient.
- Avoid Rejection
About a third of claims are rejected over eligibility issues. However, utilizing the available technology can minimize and even eliminate this issue. Your electronic health record (EHR) system should have this capability. Eliminate this problem on the front end to allow for successful payment on the back end.
- Keep the Patients
It is very uncommon for patients to be fully aware of the details of their policy and what may or may not be covered. It is important that your practice educates and informs patients of what patients owe and when. Communicate possible co-pays or other costs a patient may be liable for early on.
- Perform Internal Audits
Quite often revenue is lost merely from the fact that billing never went out. It is best practice to examine this at least twice a year through an internal audit. Questions to consider include:
- Are services being paid on
- Do the services match the
patient's explanation of benefits?
- Are the write-offs being applied appropriately and the balances corrected as necessary?
- Are services being paid on time?
- File Claims on Time
Some funding sources have expiration dates of when claims can be filed. Do not miss a filing deadline as this will automatically create a loss of revenue. Evaluate and monitor the time each step takes, from the time the patient attends the appointment to the moment the claim is submitted, posted and billed.
Getting the most out of your revenue cycle is incredibly important. Identify where issues may arise. Being proactive is the key to obtaining your maximum potential. Do not miss out on lost revenues, especially if you put in all of the work already.
Related Read: Help Your Bottom Line: Focus on Your Revenue Cycle
The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.