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On a surface level, revenue cycle management in a healthcare setting is all about the strategy that providers use to take control of both their administrative and clinical functions as they relate to revenue. In essence, it’s a way to keep money coming in the door as accurately and as efficiently as possible – all so that you can run the best medical practice that you can.
But to only see it as that would be failing to tap into its full potential, especially when you take into consideration how advanced modern day revenue cycle management tools have become.
Billing systems that are not integrated with information systems. A general lack of transparency and accountability. Unclear denials and rejections. Slow claim processing. These are just a few of the many, many issues that providers often face during the revenue lifecycle. Understanding that they are present is one thing. Doing something about them is another matter entirely.
Thankfully, the right healthcare revenue cycle management tool can help you accomplish all this and more. To properly utilize one of these solutions to maximize your own profits, there are a few key tips you’ll want to keep in mind.
The Importance of RCM in Healthcare
As stated, there are a myriad of different challenges that smaller organizations in particular face when trying to optimize their revenue lifecycle. But for the sake of brevity, two of the most important that help underline the value of RCM in healthcare are billing errors and medical fraud.
According to one recent study, the healthcare system in the United States loses an estimated $935 million every week due to medical billing errors alone. Hospital coding errors make up about 63% of that number, while 44% are directly related to both the quality and accuracy of clinical documentation.
Another study from the National Health Care Anti-Fraud Association estimates that financial losses because of fraud amount to literally tens of billions of dollars every year. Even with healthcare spending in the United States reaching over $3.6 trillion in 2018 alone, that’s still a significant percentage.
That’s why revenue cycle management in healthcare is imperative. If you could solve only these two challenges, you’d free up an enormous amount of money that can be funneled back into other areas of the healthcare system where it can do the most good. When you consider all the other ways in which the technology can help you maximize your organization’s own profits, this becomes one opportunity that is far too important to ignore.
Top 10 Tips to Maximize Your Profits
- Embrace real-time eligibility: This feature, standard in most revenue cycle management EHR solutions, allows you to verify a claim before a patient has even had a chance to visit your practice. This helps dramatically reduce the risk of rejected claims which can dramatically impact the amount of time it takes to collect money for services.
- Monitor your key performance indicators: To maximize your profits with revenue cycle management, you need to always strive for continuous improvement. You can always be doing better. Monitoring KPIs like the percentage of clean or error-free claims that you have, which should theoretically always be ticking up, will help make sure you’re always moving in the right direction.
- Close gaps between service dates and dates when claims are filed: If the gap between these two dates is several days or even weeks, you definitely have a problem somewhere. Maybe your staff are making mistakes or are bogged down with other work. Maybe you’re dealing with coding errors. Regardless, identify the issue and fix it as soon as possible.
- Pay attention to reimbursement turnaround time: If your organization is filing accurate claims, this metric should be (relatively) fast. If reimbursement turnaround time is ticking upward, you again have an issue that is preventing you from getting paid. You’ll want to address it as soon as you can.
- Lean into automation: Many modern-day revenue cycle management tools allow you to automate claims filing, which goes a long way toward guaranteeing timely filing as well. As soon as a patient receives service, your system should be configured to take care of the claim itself to maximize this revenue opportunity.
- Monitor Money collected Versus Billed: Maintain visibility into the amount of money you’re collecting compared to the amount you’re billing. You’ll never collect 100% of what you bill, but if you’re not collecting a certain amount, you’re potentially leaving quite a bit of money on the proverbial table. Use your revenue cycle management tool to pay attention to this number and if it isn’t high enough, ask yourself “why.”
- Use the built-in dashboard in healthcare RCM tools: Utilize the informative dashboard that is often built into healthcare revenue cycle management tools. This is a great way to take a lot of those KPIs outlined above and put them in one easy-to-use screen so that you don’t have to go looking for them. It gives you a bird’s eye view of your organization and acts as a “single source of truth,” letting you see exactly what you’re doing well and what you could be doing better.
- Lean into reporting: While that information dashboard is great, you also shouldn’t have to go looking for information about areas that could be improved. On a regular basis, you should be running reports to see how your healthcare organization is doing over time. This should happen automatically so that you can always see which of your efforts are paying off and so that you can guarantee you’re always making as much progress as possible.
- Emphasize following up on claims: Your revenue cycle management tool will also be invaluable in this area, as it will allow you to quickly fix any issues and ensure payer acceptance.
- Don’t forget about the patient: Finally, acknowledge that revenue cycle management tools aren’t just about interacting with insurance providers – they also have features that are designed to optimize the patient experience, too. One of these has to do with designated call centers to take patient calls to address any issues they may have on their end and to make payments easier. It would be a missed opportunity not to use them.
Unlock Your Potential with PrognoCIS Revenue Cycle Management EHR
The PrognoCIS Revenue cycle management EHR is a solution designed from the top down to not only help shorten your organization’s revenue cycle but to optimize your returns along the way. It includes several innovative features that are designed to increase the success rate of every claim, which goes a long way toward reducing denials and saving you a significant amount of money in the process.
It also helps to save time by streamlining as much of the financial process as possible. You can rest easy knowing that everything is being handled timely and accurately, all so that you can devote the maximum amount of your attention to the most important thing of all: offering exceptional patient care to everyone who walks through the door.
- Revenue cycle management is about making sure that healthcare organizations are paid for their services as accurately and as efficiently as possible.
- Modern-day tools like PrognoCIS allow for total visibility into the entirety of the revenue lifecycle, from the beginning when a patient makes an appointment to the end of the process when a claim has finally been processed.
- By streamlining revenue lifecycle management, you save time and money for your organization to focus on more effective services and better patient care. This helps eliminate losses from issues like fraud or coding errors while maximizing revenue opportunities simultaneously.
If you’d like to find out about even more ways that you can maximize your organization’s profits by way of an EHR system with revenue cycle management, or if you’d just like to discuss the specifics of your situation with someone in a bit more detail, please feel free to contact Bizmatics, Inc. today.