Revenue Cycle Management Solutions in Healthcare – 9 plus 9

Revenue Cycle Management Solutions pencil on paper with numbers

With the trending shift away from fee-based service and toward value-based care, it will become even more essential to find revenue cycle management solutions in healthcare, which are effective. Healthcare organizations face many challenges. While their primary purpose is saving lives and treating patients, they need to stay financially healthy to have the resources to do so. And to stay financially healthy, they need to collect payment. 


9 Revenue cycle management solutions in healthcare

The steps for the revenue cycle process are complex and involved. At each phase, even small errors can result in denied or delayed payments. To be sure your organization is efficient and accurate at every stage of the billing process, consider these revenue cycle performance measures.

  1. Track key performance indicators (KPIs) throughout the billing process. Tracking KPIs helps management see areas that are weak and need improvement in the revenue cycle. By tracking a claim through its entire life cycle using an analytics tool, you’ll be sure that claims and charges don’t fall through the cracks. You’ll also get a good look at your overall financial health and determine the areas that need improvement. You can do this by receiving reports regularly, either daily, weekly, or monthly, based on your needs. These reports are critical to gaining an overall view of your financial health and identifying leaks in the process. 
  2. Hospital Revenue Cycle Best Practices.  Remember that hospital revenue cycle management inefficiencies cost providers millions each year in lost income. When examining hospitals collectively, this figure leaps into the billions.
  3. Physician Revenue Cycle Key Indicators of Best Practices. High-performing practices have a shorter collection period, typically no more than 36 days.
  4. Use automation to save time and prevent errors. Claims are often denied due to errors in collecting patient information. Manually determining patients’ demographics and insurance eligibility can be time-consuming and often leads to human error. Automating as much as possible will improve staff workflow and increase accuracy. Medical billing software can be used to automate tasks like patient preregistration, coding, charge posting, and electronic remittance. This will help your billing department save time and improve accuracy when they make claim submissions.
  5. Offer transparent pricing. Let patients know upfront what the costs of services are. Communicate with them early on about your billing procedures. Your staff should be able to answer patients’ questions about pricing over the phone or in person. Educate your staff to deal with patients professionally and courteously. Let the patients know you understand financial burdens and explain the payment plan options to them. 
  6. Train your staff. This is a key way to ensure your revenue cycle is as efficient as possible. Your staff needs to complete regular training in programs that teach in-depth chart documentation, proper coding techniques in billing, and financial policies. Rules and regulations can change frequently. Be sure your staff is regularly kept up to date on the changes. Physicians should also be included in coding training. 
  7. Offer patient access to view bills and pay online. Provide a payment portal for patients – one that conforms to HIPAA regulations, of course. Giving patients greater control and access to payments reduces payment defaults. And integrating the payment portal into your billing platform will increase efficiency, reduce errors, and save your staff time. 
  8. Incorporate artificial intelligence (AI). AI is currently making huge strides in many industries. AI is already being used in the clinical side of healthcare to improve care and reduce human error. But the clinical side isn’t the only area where AI can be beneficial. AI can be used to predict claim denials, find trends in denials, streamline the revenue process, improve coding, and reduce errors in clinical documentation. The opportunities are endless for healthcare automation
  9. Conduct a third-party assessment of all aspects of your revenue cycleA case study by The Fox Group, LLC consultants to the healthcare industry, demonstrates how a 30-day evaluation of the operations of the billing department, resulted in a dramatic increase in cash flow.  Among many issues, The Fox Group found the provider was averaging 260 days from the date of patient care to the date of payment. Staff members weren’t taking advantage of electronic resources. As a result, inconsistencies in the billing process resulted in large amounts of uncollected revenue. The experts at The Fox Group were able to assist the organization by recommending actionable steps that created a sustainable financial performance.


9 Best practices for revenue cycle management

By following best practices, you can be sure your revenue cycle doesn’t falter during any one of these common problems.

  1. Patient check-in and check out process. The information obtained during preregistration should be confirmed. This includes verifying the patient information, getting copies of insurance cards, confirming insurance eligibility, and notifying patients of prior and new balances. The decision must be made if your organization will collect payment up-front or at point-of-service. Collecting payment at point-of-service has become more critical as patient deductibles have risen, and they are now responsible for larger percentages of their bills.
  2. Charge capture. This is the process of documenting information for the care that was provided. The information must be entered correctly to avoid errors at the beginning of the revenue cycle. Providers need to regularly update service pricing to ensure accuracy and completeness in billing. 
  3. Charge entry. Charge entry is the next step in billing. Information needs to be entered, including the date of service, the physician who performed the service, and procedure and diagnosis codes. This is a critical step, as any error entered here can increase the risk of denied or delayed claims.
  4. Claims submittedThis is when the claims are submitted to the insurance company. The healthcare organization needs to be sure to comply with the insurance company’s requirements and use the correct codes. It’s beneficial for an organization to have a system in place that allows for easy error correction in billing and claims processing.
  5. Patient statements are sent out. Statements of charges due sent to patients should be clear and easy for the patient to understand. Organizations should engage in cycle billing, where patients are invoiced on a monthly schedule instead of billing all accounts at once. 
  6. Payment posting. Payments received need to be logged into the system. This is the stage when contractual write-offs are entered, denials and adjustments are reviewed, and insurance reversals are processed.
  7. Follow up with insurance carriersThe billing department must verify that the insurance companies are receiving and processing claims. Your average days in accounts receivable should be audited, and collection rates recorded. 
  8. Claims denial. Analyze the reasons for claims denied to find out the causes and improve your claims processing procedures. Denied claims need to be resubmitted with corrected coding or other changes to attempt to collect payment. 
  9. Accounts receivable. Ideally, the patient will have been given an estimate of the cost before their appointment. After patient billing statements are sent, collection letters need to be sent for late accounts. Patients should be offered options for payment plans. By offering plan choices for patients, you allow them to receive care even when the costs might otherwise be prohibitive. You can receive small payments over time without having to turn the patient over to a collection agency, where you may collect only a portion, if any, of the bill.


First next steps

If you are wondering what to do next, download this free revenue cycle best practices for healthcare checklist.  A medical group may also consider a comprehensive practice assessment to find out whether the billing and collections process is operating as efficiently as possible. 

A new focus on revenue cycle management solutions in healthcare will certainly provide a more sustainable financial performance!  The healthcare industry is challenging enough, make sure that your revenue will provide you with the financial resources to provide best patient care.

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