Are you happy with your revenue streams?- most healthcare organizations aren’t. This often comes down to preventable errors with the revenue cycle management (RCM) process. This makes it super important to perform a revenue cycle management assessment.
However, some physician practices get stuck on finding the best process and system functionality for their revenue cycle management assessment. And it's easy to understand why - with constantly changing industry regulations, keeping up with the newest systems is often the last thing a manager or healthcare provider thinks about.
But don’t worry. By taking it step by step, this assessment process becomes much more manageable and less stressful.
How to Improve Revenue Cycle Management
Improving your revenue cycle management (RCM) involves a strategic approach that blends technology, staffing, and processes to maximize efficiency. Start by focusing on clean claims. Clean claims mean less rework and fewer denials, directly impacting cash flow. Ensure your claims are accurate and complete before submission to reduce errors early on.
Next, consider the role of encounter data management. This involves capturing accurate and detailed patient interactions, which not only streamlines the billing process but also aids in thorough documentation for claims. It’s important to maintain precise records that reflect the services provided.
Denial management should also be a critical focus area. Implement a systematic approach to categorize and analyze denials. Determine common patterns, their root causes, and take corrective measures to prevent future occurrences. Proactive denial management can significantly improve revenue recovery.
Leveraging technology is another key strategy. Integrating advanced RCM software can help automate tasks, streamline workflow, and improve the overall patient experience. Automation can reduce collection costs and enhance tracking accuracy, making processes more efficient.
Lastly, address staffing challenges by hiring and training qualified staff. Alternatively, consider outsourcing certain RCM functions to specialists, which can free up resources and enhance efficiency, especially vital for rural hospitals where resources may be limited. Provide ongoing training to ensure your team is well-equipped to manage evolving RCM demands.
Incorporating these best practices not only optimizes the revenue cycle but also contributes to the financial sustainability of healthcare organizations by reducing waste and improving cash flow.
Top Tools for Revenue Cycle Management
Embracing the right tools can be a game-changer for your healthcare organization's revenue cycle management. In today's digital age, innovative RCM software solutions provide sophisticated functionalities encompassing claims processing, denials management, and comprehensive data analytics. These tools not only streamline processes but also ensure a cleaner, more efficient billing cycle.
1. RCM Software Suites: Leveraging advanced RCM software can automate repetitive tasks, minimize human errors, and expedite billing cycles. Implementing these suites allows for seamless contract management, real-time revenue tracking, and proactive denials management.
2. End-to-End Analytics: Tools that offer end-to-end revenue cycle analytics are pivotal for benchmarking performance metrics and identifying areas for improvement. By analyzing the complete revenue cycle, you can pinpoint inefficiencies and adapt strategies to optimize financial outcomes continuously.
3. Patient Experience Platforms: Integrating platforms that enhance the patient experience can lead to higher satisfaction rates and improved collections. These tools often include self-service portals for patients, which facilitate faster payments and reduce administrative burdens.
4. Encounter Data Management Systems: Accurate encounter data is crucial to successful billing. Tools that efficiently capture and manage encounter
What Is a Revenue Cycle Management Assessment?
A revenue cycle management assessment involves closely evaluating your entire billing process - from the first patient interaction to the collection of payments. The goal? Uncover areas for improvement and maximize revenue.
Why a Revenue Cycle Management Assessment Matters
A 2021 survey on the healthcare industry showed that almost all professionals desired improved processes, like those associated with RCM. You might even be one of them. Because without an efficient revenue cycle, your practice will continue to struggle with claim denials, delayed payments, and frustrated patients.
You could lose serious cash flow. That's why it's essential to schedule a revenue cycle management assessment and do it consistently, ideally every quarter (but at least annually).
Benefits of Revenue Cycle Management Assessment
A revenue cycle management assessment is like a check-up for your business's finances. It can help you find and fix any problems in the way you bill and collect money. This can save you a lot of headaches down the road.
But a revenue cycle management assessment can do more than just identify problems. It can also help you:
- Boost your income: By finding and fixing billing errors, you can make sure you're collecting all the money you're owed.
- Speed up payments: A good assessment will streamline your billing process so you get paid faster.
- Make your patients happier: By making it easier for patients to understand and pay their bills, you can improve their satisfaction.
A revenue cycle management assessment can be especially helpful for businesses that are struggling with:
- High claim denial rates
- Slow payment turnaround times
- Frequent billing errors
- Poor patient satisfaction scores
5 Steps to Performing a Revenue Cycle Management Assessment
The best approach for any assessment includes taking an honest look at where your revenue cycle falls short. To do that, you must create an action plan.
To start off, here are some simple steps to consider as part of your revenue cycle management assessment process:
Step 1: Identify Inefficiencies
The initial stage of your revenue cycle management assessment requires looking for any bottlenecks or processes creating major (or even minor) hiccups for your team. Here are some to consider:
- Are there errors with patient registration that could be resulting in denied claims? These often happen when patient data isn't kept up to date.
- Are your claims being submitted on time and to the correct insurance payers? This often happens with medical billing - especially if there is not a consistent process used.
- Do you struggle to get your patients to pay their portion of the medical bill at the point of service? Implementing tools, such as AnodynePay, Artemis, or even Zeus as part of your point of sale system, can really reduce friction from patient collections. Most of these tools allow payments in installments.
- Is following up on denied claims and billing tasks like pulling EOBs from your clearinghouse not a consistent practice? Doing things like creating process documentation for your entire team will create greater transparency and fewer errors (which results in fewer denied claims and fewer complaints from providers about lower than expected paychecks)
Step 2: Analyze Current Processes
Think of your practice as a detective conducting an investigation into the case of missing revenue. A critical aspect of any investigation involves following the evidence trail. Similarly, with your assessment, look at all RCM processes for how patient data flows to the corresponding departments:
Keep in mind these questions are just the tip of the iceberg. Because each specialty (cardiology, oncology, mental health) has unique requirements around documentation and medical coding, the revenue cycle management process for each can look very different from another practice.
You’ll likely think of additional tasks for your action plan for your individual assessment process. For example, if your practice is a surgery center, your RCM process will look different than one that is a behavioral health practice.
Step 3: Gather Data and Establish Clear KPIs
The next step involves reviewing claims and reimbursement trends:
Don't forget to look at your clean claim rate as part of this process. Pulling this data from your clearinghouse is simple and doesn't take much effort. By closely reviewing key performance indicators, your medical practice can implement changes to optimize the entire revenue cycle, from pre-registration to patient collections.
Step 4: Technology and System Integration
Do your electronic healthcare record system (EHR), billing software program (such as Bill.com), and patient portal all work seamlessly together? This is where many practices fall short - either they’ve implemented one software without checking if it integrates with existing tools.
Sometimes they try using numerous spreadsheets to make up for their lack of a system. If your healthcare team dreads their job due to cumbersome systems, then your revenue cycle assessment should evaluate your tech stack.
Step 5: Staffing & Training
You already know that everyone is short-staffed and burnt out. So much so that over 90% of professionals surveyed are searching for improvements to data management.
You’re likely included in those statistics (HealthITAnalytics) and don’t even realize it. What's the first thing managers cut back on to save money? Training.
But if there is a high turnover of billing staff, then claims and billing often fall behind. This can result in massive financial losses - this highlights why ongoing training, feedback, and a culture of continuous improvement are paramount for a thriving RCM.
Does your staff get ongoing professional development opportunities (such as attending coding conferences or billing webinars) so they’re confident about navigating changes with insurance payers and current industry regulations?
Ongoing education is critical in the healthcare landscape. Make sure you set your revenue cycle team up for success by equipping them with the best resources, systems, and knowledge to get the job done.
How To Implement Changes Based on Assessment Findings
So you had your revenue cycle management assessment. Now you have a list of things to fix. It might feel overwhelming, but don't worry - it's totally doable.
You'll want to make a plan and take things one step at a time.
1. Prioritize what needs fixing ASAP
Look for quick wins. These are things you can change quickly, without spending a lot of time or money. Maybe your billing software needs a quick update, or maybe you can tweak some forms to be easier to read.
One of the things you may need to implement is adding a tool that will help reduce errors from repetitive typing. Magical is the answer to this. Magical is a free Chrome extension that helps healthcare admin teams save 7 hours a week (on average) on repetitive typing tasks that result in errors (and delayed payments).
You can set up one-click automations easily between any two healthcare apps or systems without the need for coding or APIs. This means no more copying and pasting!
2. Spend time on long-term goals
After that, focus on the big stuff. These might take longer, but they'll have a bigger impact in the long run.
For example, you might need to revamp your whole patient registration process. Or maybe it's time to look at new technology, like automated billing systems.
It seems like a lot, but remember, this is a marathon, not a sprint! Break it down into smaller goals. That way, you can celebrate each victory along the way.
How To Future Proof Your RCM After An Assessment
After an assessment, you want to use what you learn so you can get to maximum profitability. You'll probably get a list of things to work on.
Don't try to tackle everything at once. Pick one or two things that will make the biggest difference for your healthcare organization.
Maybe your assessment showed you need better denial management. That means finding out why insurance companies are rejecting claims. This is a great place to start improving.
You could also look at patient access. This is how easy it is for patients to schedule appointments and understand their bills. When you make it easier for patients, they're more likely to pay on time.
Don't Neglect Your Revenue Cycle Management Assessment
You now know how vital consistent revenue cycle management assessment is to optimize revenue. This ultimately allows healthcare providers to focus more on patient care, leading to an overall better patient experience for everyone - from the patient scheduling their appointment to the billing specialist capturing final payments and sending out monthly patient statements.
If increased errors resulting from repetitive typing are an issue that comes up in your revenue cycle assessment, then try Magical. Magical is used (and loved) at more than 50,000 companies and by over 700,000 users to save 7 hours a week on admin tasks. Try it for your team today!
