As in any other business, revenue is crucial for keeping your healthcare agency functioning like a well-oiled machine. However, medical billing processes are often complex. Other businesses can submit an invoice directly to their clients and get paid within a month or so. In healthcare, you may be working with the Centers for Medicare and Medicaid Services (CMS) and other insurance companies. You have to record detailed information and submit a claim to these companies, only to have it rejected if you haven’t included the right information. For this reason, it takes longer for you as a provider to get paid for services.
About half of providers experience challenges due to large patient balances. Implementing revenue cycle management in your healthcare facility can help you collect faster to boost your cash flow and help you operate more sustainably. Learn more about revenue cycle management and how you can make it work for your business.
Revenue cycle management in healthcare goes beyond billing. It is a strategy that improves your financial performance by reducing how long it takes you to be reimbursed for your services. Working with a revenue cycle management company, you develop a process to track patient care from beginning to end and organize all revenue-generating activities.
Revenue cycle management starts with patient registration and ends when you’ve collected payment for your services. Each step is crucial for submitting clean claims and speeding up the time between treating your patients and getting paid.
A strong revenue cycle management strategy shortens your average accounts receivable times, helps reduce claim denials, and improves your company’s financial health. It can also improve patient satisfaction, because your patients aren’t getting unexpected medical bills long after they’ve received treatment.
To implement a successful revenue cycle management strategy, you need to understand each step in the cycle.
The revenue cycle begins when a patient requests an appointment or is referred to your facility by another healthcare provider. At this stage, you collect information such as your patient’s:
Name
Address
Date of birth
Phone number
Insurance information
This is one a crucial step in revenue cycle management. By verifying a patient’s insurance coverage and eligibility before you treat them, you prevent claim denials while staying compliant with healthcare regulations.
Call the patient’s insurance company to verify that they still have an active policy. Next, verify what is covered and what the patient will be expected to pay. Having this information available at the beginning of your patient’s appointment lets you set expectations and keeps your patient from receiving an unexpected bill.
Charge capture involves documenting all billable services, supplies, and procedures. Keeping accurate records and coding them properly helps you recover the maximum repayment from your patient’s insurance company. It also helps reduce claim denials, because you can submit clean claims.
Using RCM software to automate charge capture keeps you from underreporting and missing revenue or overreporting for services you didn’t provide because you pre-loaded your charges based on a patient’s past history with your practice.
At this stage in revenue cycle management, your administrative team compiles claims and sends them to insurance companies for payment. This step is crucial for timely reimbursements. Accurate coding, thorough documentation, and following payer-specific guidelines reduces claim denials, which lowers your accounts receivable.
If you’ve submitted a clean claim, you will get paid. Your administrative or billing team applies each payment to the proper claim and sends the money to your company’s bank account. If you haven’t submitted a clean claim, you will receive a claim denial from the payer.
You likely have members of your billing team to review and process denials. This team usually follows up with payers and resubmits claims with corrected coding, documentation, and other requirements for payment.
Insurance is constantly evolving, and rule changes present one of the largest hurdles to revenue cycle management in healthcare. You can overcome this challenge by designating people on your team to stay current with policy changes, or outsource revenue cycle management services and work with a revenue cycle manager who understands and tracks insurance policy changes.
Technology can also help you overcome common RCM challenges, including billing and coding errors and denied claims. RCM software can scan your claims and flag billing and coding errors so you can correct them before submitting your claim.
You can also take a proactive approach to RCM by assessing claim denials and looking for trends and patterns. You may notice a common error that requires more training. Or you could improve your charge capture and coding processes so your claims are correct the first time.
Technology is playing a crucial role in revenue cycle management for healthcare agencies like yours. Tools such as AI and automation help assign the right charges and codes for each patient chart. These medical billing optimization tools can also scan claims and flag errors or missing records so you can correct them before submitting them for payment.
Cloud-based RCM software integrates with electronic health records to automatically match patient records with claims. It also gives you a detailed audit trail to stay compliant with healthcare regulations.
Patient engagement tools, including automated appointment reminders and digital registration and check-in, helps you process their paperwork and verify their insurance before each appointment. You can then walk your patient through their service and explain what is covered and what isn’t. They don’t have surprise bills, and you can collect patient payments at the time of service.
Financial responsibility can improve how you care for your patients. You can’t effectively treat them when you’re chasing down dollars for past services, which is why you have Puredi. We offer end-to-end services to manage revenue and improve your reimbursement rates. Choose from medical billing and coding software to full healthcare revenue cycle management services.
Our team has over two decades of experience in medical billing services. We understand the ever-changing insurance landscape and know how to create clean claims that help you get paid faster. Perfect every step of revenue cycle management at your practice with our help. Schedule a demo today to find out what we can do for you.