Revenue Cycle Management

Revenue Cycle Management

Offering the best care possible to your patients is your main priority, but that won’t be possible for long without some emphasis on the financial health of your organization. Revenue cycle management (RCM) refers to the process of both optimizing and managing your revenue workflow to ensure you remain financially viable. The process begins with patient registration and ends with collections.

The goals of an effective RCM strategy include identifying and resolving financial issues, and avoiding negative cash flow. A good RCM strategy will help you reduce accounts receivable, streamline collections, and avoid insurance claim denials.

A major part of RCM is maintaining a line of communication with health insurance networks to verify patients’ benefits. Without doing this, there is a major risk of generating a faulty bill. This will result in claim denial, and potentially put your patients in a catastrophic financial situation.

What Distinguishes Revenue Cycle Management?

Many practitioners think RCM, medical billing, and medical billing services are different names for the same thing. While all three of these tasks are typically managed by the same outsourced company, they do differ significantly.

The goal of RCM is to track and analyze your finances. This is accomplished through the use of software that keeps detailed records of your billing, reimbursements and payments. At Healthcare Revenue Group, we use eCW (eClinicalWorks) to handle billing and track your financial metrics to perform RCM. Our analysts work to find the pain points in your RCM and make the right changes to increase your financial performance.

By contrast, medical billing is the process of submitting error-free claims to insurance companies. Medical billing services provide assistance with claim submission, and follow-ups on delinquent accounts and claim denials. Medical billing and medical billing services are like the nuts and bolts of medical financial services, while RCM is focused on the big picture.

The Revenue Cycle Process

There are seven steps to an effective revenue cycle, and they must all be implemented and followed closely to allow the system to work for you.

  1. Patient Preregistration

    A new patient requires an assigned patient coordinator. The patient can complete an intake form through an online patient portal. It’s important to collect demographic information, as well as medical and insurance details. They should be informed of their financial responsibility vis a vis their deductibles, copays and referrals. Also inform them of your no-show and cancellation policies. Remember that patients sometimes change their insurance providers, which is why it’s important to update the files of all recurring patients.

  2.  Verification

    All patient data must be verified to be 100% accurate. Run insurance eligibility checks to make sure that claims will not be denied. Get prior authorization for any and all treatments and services you intend to provide. Without verified data, you may end up having financial repercussions to deal with. That can cost a good deal of time and money!

  3. Charge Capture

    This is where we find a lot of revenue leaks. After a patient’s care delivery cycle is complete, it’s time to document all services and treatments that were administered. Double-check encounter forms before submitting them to billing. This can be especially challenging when it comes to emergency services, where things happen so quickly that it may be impossible to remember exactly what you did. For example, a physician may have employed sutures but billed for staples. These methods have a different billing structure, and revenue may be lost.  Digital tools like those that can be built into the eCW software can make this process more streamlined and easier to complete accurately. Accurate charge capture is essential to effective RCM.

  4. Medical Coding

    Insurance companies can sue medical practices if they detect illegal coding practices, such as coding for a more costly procedure than was performed or “unbundling” a CPT code to bill multiple times for one procedure. The CDC (Centers for Disease Control and Prevention) regularly updates codes, so you need to ensure that your database is relevant. HRG handles this for our clients through the eCW software.

  5. Claim Submission / Denial Resolution

    The standard CMS-1500 format is common for most specialty practices, aside from dentists’ offices. It’s best to scrub claims for discrepancies before sending them to insurance providers. HRG provides this service to our clients, finding formatting and coding errors before they cause a delay in payment processing. We also handle denial resolution, adjusting and resubmitting claims. Our process decreases the denial rate to about 2%.

  6. Remittance Processing

    RCM experts can help with remittance processing. Remittances are sent with payment or denial from an insurance provider. They explain why services or treatments were covered or not. It’s important to post payments soon after receiving remittances. Cross-checking EOBs will help you to identify errors, and allow you to make appeals when required.

  7. Patient Collections

    Once accounts have been settled with the insurance provider, you need to collect the portion of your fee that the patient is responsible for. This can be a difficult task. Regular follow-ups are important to ensuring you get paid on time. The eCW software can send automated payment reminders, easing the burden of this task, while also allowing patients to pay online.

If you are interested in assistance with revenue cycle management, medical billing, and medical billing services for your practice, contact Healthcare Revenue Group today. We work with medical practices of all kinds, and have special expertise in podiatry, audiology and hearing care.

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