Revenue cycle management best practices

Revenue cycle management best practices

Effective RCM involves streamlining the billing process, verifying patient eligibility and insurance coverage upfront, and using data analytics to monitor and improve performance. It also requires staff training and communication to ensure smooth operations. By implementing the following best practices, healthcare businesses can optimize cash flow, reduce denials, and improve the patient experience. Ultimately, adopting best practices in RCM is essential to maximizing revenue and ensuring the financial health of the organization.

Tips to improve revenue cycle management best practices

• Make the patient the center of the procedure

Improving revenue cycle management (RCM) requires a focus on patient-centered care. Putting the patient at the center of the process is perhaps the most important step to improving revenue cycle management best practices. This means prioritizing the patient experience by communicating clearly about billing and insurance coverage, offering flexible payment plan options, and addressing any concerns or questions promptly.

• Invest in technology

Investing in technology is another key step to improving RCM best practices. Technology solutions can automate and streamline the medical billing process, reducing errors and increasing efficiency. This includes using an up-to-date electronic health record system and practice management to manage patient data and automate the billing process.

• Get payment from the patient before services are provided

Collecting patient financial responsibility before services are rendered is a critical step for improving RCM best practices. Verifying patient eligibility and insurance coverage upfront can help avoid denials and reduce costs associated with collecting patient balances after the fact. Healthcare businesses should use technology solutions to automate the process of checking eligibility and insurance coverage, making it easier and more efficient for staff to manage. In addition, be transparent about the costs of service and communicate clearly with patients about their financial responsibility.

• Automate prior authorizations and eligibility

Prior authorizations can be time-consuming and costly, requiring staff to manually manage the process of obtaining approvals from insurance providers. Automating this process can significantly reduce the time and cost associated with prior authorizations while also reducing the risk of denied claims. Similarly, automating eligibility verification can help ensure that many patients are covered for the services they receive, reducing the likelihood of denied claims and rejections. 

• Improve charge capture and coding

Accurate charge capture and coding are essential to ensuring that healthcare businesses are appropriately reimbursed for the service they provide. This includes capturing all services rendered, documenting them accurately, and assigning the correct codes. Healthcare businesses can use technology solutions to automate charge capture and coding processes, reducing errors and increasing efficiency. Staff training is also essential to ensure that they understand how to accurately capture and code charges. Additionally, healthcare businesses should regularly review and audit their charge capture and coding processes to identify and correct any errors or inefficiencies.

• Timely filing of claims

Filing claims promptly is essential to avoid missed revenue opportunities and potential denials. Healthcare businesses should establish clear timelines for submitting claims as well as procedures for monitoring and tracking claims throughout the process. This can include using technology solutions to automate claim submission and tracking, reducing the risk of errors and delays. It is also important to ensure that staff are trained on the importance of timely claim submission and understand the consequences of missed deadlines. Regular review and monitoring of claims submission timelines can help identify and address any inefficiencies or issues in the process.

• Denial Management

Denials are a common issue in healthcare billing, and managing them effectively is essential to minimize revenue loss. Establish clear denial management processes, including procedures for identifying and resolving denials promptly.

This can include using technology solutions to automate denial management and track the progress of rejected claims. It is also important to identify the root causes of denials and implement strategies to address them. This may include staff training, process improvements, and regular review and monitoring of denial trends. 

Conclusion

If you're looking for a partner to help you improve revenue cycle management processes, Prosperis Consulting is here to help. Our team of experts has years of experience working with healthcare businesses to optimize their RCM processes, reduce denials, and enhance revenue. By working with Prosperis Consulting, you can gain access to our suite of RCM services, including charge capture and coding, denial management, and technology solutions for automation and optimization. Our team is committed to helping you achieve your financial goals while enhancing the overall patient experience.

Contact us today to learn more about how we can help you improve your revenue cycle management practices and achieve greater financial success.