Overview
According to Global Market Insights, the projected market value of healthcare revenue cycle management will be more than $275 billion by 2028. This astounding figure goes to show how important revenue cycle management is to healthcare providers.
Revenue cycle management best practices protect the profitability and back-end operational efficiency of an organization. Keeping revenue cycles consistent means more financial stability within the organization. However, many healthcare providers struggle with revenue cycle improvement. Take a look at how to improve revenue cycle management as a healthcare provider.
How to Improve Revenue Cycle Management in Healthcare
Invest in Staffing
Having the right team is critical to every level of providing medical services, right down to collecting patient payments and ensuring revenue is properly managed. You can have all the proper tools in place, but if the staff is not trained enough to use those tools and methodologies, revenue cycle management can suffer. Investing in staff may mean:
- Providing the right level of training and guidance
- Ensuring staff members are continually educated on communicating with payers and patients
- Providing adequate training for using billing technology or data entry
Another important aspect of investing in staffing is building up collaboration in the workforce of your organization. Make sure there is consistent connection between different roles and departments. For example, you may have one individual handling coding and billing, but another handling claim denials. If these two individuals are interconnected, the denial can be mitigated quicker.
Update Processes Regularly
Revenue cycle improvement relies heavily on staying on top of internal processes. Issues with revenue are notorious for starting small but growing more problematic the longer they are neglected. For example, if you recognize early that your denial numbers are high, updating processes immediately to negate those denials is crucial. Claims denials are bound to happen. The latest CMS data shows that roughly 18 percent of all in-network claims are initially denied. However, implementing regular audits on denials helps clarify root causes so they can be avoided.
Utilize data analytics to maintain a clear view of your revenue cycle management processes. Use financial data analytics to look at performance indicators, monitor lags in payments, and see how many denials are occurring. Monitoring this data can help you pinpoint areas of concern and make changes to keep revenue cycles where they should be.
Give Patients Multiple Ways to Pay
The more convenient it is for patients to pay their bills, the more efficiently those payments will be made. Ensure patients have access to multiple ways to pay their bills and patient experience and revenue management improves. A survey conducted in 2021 found that over half of patients preferred access to contactless payment methods, online bill pay, and mobile wallets to pay their bills. Another interesting fact, almost half of survey respondents said that paying medical bills was harder than paying anything else.
Keep a Handle on Insurance Eligibility Verification
One of the most overlooked revenue cycle management best practices is to be more stringent about patient insurance verification. When new patients step in for treatment, make sure insurance is verified before treatment is provided. If pre-authorizations are necessary, have a good follow-through plan in place to make sure they are handled in a timely way. Around 99 percent of Medicare Advantage participants have plans that make prior authorizations necessary. If a provider does not check for these requirements in advance, it can lead to patients with bills they cannot afford to pay in a timely manner.
Quality Billing and Coding
High-quality billing and coding is the foundation for deterring undue denials. If you rely on in-house billing and coding, make sure those staff members are constantly refreshed and retrained, so they are educated with the latest changes. If you struggle with getting satisfactory results from an in-house team of medical coders, consider outsourcing to a company that specializes in medical claims billing.
The outsourced medical claims market is projected to grow by more than 11 percent annually in th coming years. This is due to the fact that many providers have found outsourced medical billing more efficient.
Practice Timely Denial Management and Followups with AR
Implement a strategy to manage claims denials in a timely way. Denials account for as much as 90 percent of lost revenue in healthcare. Additionally, each denied claim can cost an average of $31.50 due to the time and costs of revisiting that claim. Make sure followups in accounts receivable are a mandatory part of administrative workflow so denials don’t sit idle longer than necessary.
Maintain Physician Credentialing Processes
If an organizations physicians are not properly credentials, this created problems collecting payments from payers. In 2021, 54 percent of practices claimed that denials due to provider credentialing issues were on the rise. The varied requirements among payers and frequent changes to provider credentialing requirements can make this a complicated but necessary process for revenue cycle improvement.
Streamline Monthly Reporting
Make sure financial data reports are streamlined across all avenues of the practice. Revenue cycle management best practices exceed only keeping close tabs on billing and denials. A streamlined report should take claims denials into consideration, but also offer in-depth overviews of other financial elements of the business, such as operational costs, billable physician hours, and more. In-depth reporting allows practices to analyze all financial data collectively, fix loopholes, spot revenue growth and loss trends, and more.
How PrognoCIS Can Help Your Practice Improve Its Healthcare RCM
PrognoCIS Healthcare RCM solutions are designed to target the growing challenges providers face with navigating the delicate balance of providing patient care and maintaining profitability. Our RCM solution combines payment collections and EHR workflow into one place. By utilizing RCM services, PrognoCIS clients have experienced a 45 percent increase in annual revenue. These increases are due to complete, intelligent claim monitoring and a higher rate of claims accepted the first time they are submitted.
Ready to implement revenue cycle best practices? Contact PrognoCIS to request a demo.
