- An optimized Revenue Cycle Management (RCM) process is crucial for a successful practice
- Three ways to improve your RCM process: implement a financial clearance process, utilize modern technology and implement a comprehensive dashboard
Healthcare organizations (HCOs) reside in a turbulent economic climate. They face increased pressures from government and commercial payers when dealing with the ever-changing regulations on reimbursement. Regardless of the size of your practice, it’s imperative to review and update your Revenue Cycle Management processes to ensure financial success. Navicure has released a white paper written by RCM consultant Elizabeth W. Woodcock, MBA, FACMPE, CPC on how to improve your RCM. We’ve previewed a few of their tips here.
1. Implement a financial clearance process
Financial clearance is the “process of verifying insurance coverage, benefits eligibility and financial responsibility, including unmet deductibles, and, importantly, communicating that information to the patient.” It’s essential to keep patients financially responsible, or “in the know” about charges at all times, lest they blame the provider. Having patients understand the financial responsibilities empowers the patient. Just as an EHR can enhance the patient-provider relationship, educating patients about the financial side of healthcare can boost patient satisfaction and health outcomes.
2. Utilize modern technology
Electronic health records (EHRs) are vital to a successful practice. They are the tools which allow providers to handle medical record keeping (EMR), as well as finances (practice management software). Practice management software offers significant advantages; namely, it helps to improve cash flow, reduce costs, and enable staff to work smarter.
With a sound practice management system in place, look for ways to automate these critical functions:
- Insurance coverage and benefits eligibility: Verifying your insurance and confirming the patient’s insurance information with the payer can be cumbersome and error-prone. Having an automated system with scrubber checks reduces the chance of claims rejection.
- Charge capture: An integrated solution of electronic medical records and practice management automates capture codes when filing a claim. The key is to eliminate the data entry of codes from paper charge tickets to the practice management system – which, as Woodcock states, is “a manual process that consumes hundreds of hours each year for physicians and their staff, and introduces the prospect of errors through mistypes or omissions.”
- Clearinghouse: Utilize a reputable clearinghouse that practices with integrity and honesty.
In addition to these functions, PrognoCIS believes the following are also crucial:
- Patient Portal: a secure and easy-to-use way for patients to make online payments, schedule appointments, and message physicians.
- Data analysis tools: In this modern economy, the proper analysis and utilization of data are what makes or breaks a company. Being able to take data and present it visually, as well as transforming it into actionable tasks, is key to success. Modern tools like population health management and medication adherence analysis-es can ensure the optimization of your practice.
3. Implement a comprehensive dashboard
Work with a vendor that has a developed a dashboard which has easy-to-read displays. Key indicators of revenue cycle performance include the following metrics:
- Days in accounts receivable (days in A/R): Accounts receivable is the most common performance indicator of the performance of your practice.
- Receivables over 120 days: Aging buckets over 120 days is an essential feature of a dashboard. Aged receivables are ” more costly to collect, and the probability of collection dips, the fewer receivables in this category, the better off you are.” Monitor this section frequently and try to reduce it as much as possible.
- Adjusted collection rate: Collecting a full charge from an insured patient is rarely possible because of contractual adjustments. An adjusted collection rate feature measures what is collected, divided by what should have been received. Make sure your practice management system accurately reports this measure.
- Denial rate: Another important feature, the denial rate is the percentage of claims denied by payers. A lower percentage denial rate means your organization’s cash flow is better, and less personnel is needed to manage denials.
The efficiency of a practice’s revenue cycle is dependent on all clinical staff. Everyone, from the physicians to the managers, must be able to understand and facilitate the processes in play. An inconsistent or untrained approach to RCM creates uneasy patients. Uneasy patients are loathed to do business. Whether you plan on adopting new technology or revisiting and improving old tech, it’s essential to do a review of your revenue cycle management process.
The financial climate of healthcare is always changing. With the new regulation, payment models, and health policy, understanding and adapting to the technological environment will keep your practice successful and prosperous.
Learn more about what PrognoCIS has to offer, including comprehensive practice management software, an easily accessible patient portal, expert Revenue Cycle Management services.