One of the most crucial business tasks for many providers is revenue cycle management, or RCM. For tiny practices, it's what "keeps the lights on," and for huge health systems, it helps sustain healthy operating margins.

But regardless of how many claims a billing team submits, revenue cycle management procedures must be straightforward and effective from the outset. It should be a regular goal to learn how to enhance revenue cycle management and something that is consistently worked on. If not, healthcare providers might be losing out on revenue in addition to degrading patient satisfaction and possibly causing staff fatigue.

The cornerstones of effective revenue cycle management

Just getting one claim to the appropriate payer and having it paid in full involves a number of roles and duties; imagine having to submit several claims daily, rectify denials, locate more active coverage, and gather new patient data on top of that. Although revenue cycle management is a complicated process, billing teams can ensure success by adhering to a few best practices.

Verifying one's eligibility is an essential initial step. This is the process by which a healthcare professional verifies that a patient has active coverage, which entails having the ability to bill the patient's insurance company instead of expecting full payment. Patients typically lack the resources to pay their bills in full, therefore this is advantageous for the provider.

Submission of claims is the next step. The billing staff is in charge of filing a claim to the appropriate payer with all the necessary codes to identify the type of care provided once the patient has received treatment. With over 10,000 medical billing codes1 available, billers have their work cut out for them making sure they're always utilizing the correct codes.

Lastly, billers have the option to revise rejected claims to fix errors and resubmit them for payment. We call this kind of behavior "denial management."

Notwithstanding the seeming simplicity of eligibility verification, claims filing, and denial management, there are several obstacles that may arise during the process. Consequently, providers might undertake supplementary measures to enhance their revenue cycle management.

Ways to enhance the management of revenue cycles

The greatest approach to enhance revenue cycle management is to dissect the procedure into its component parts and concentrate on optimizing each one's efficiency. Take into account every aspect, from the initial patient encounter to the last payment. Don't forget to account for staff involvement and billing resources.

Make patient access easier

The new patient process as a whole is called patient access. Eligibility verification is one step in the process, as was previously noted, but it is not the only one.

Verifying patient demographics, such as first and last name, current address, and Social Security number, is another aspect of patient access. It's also advisable for providers to verify any additional coverage beyond what the patient has supplied. Patients frequently have secondary or even tertiary coverage that they have not declared or are unaware of. There are still two more possible payers to submit claims to!

The finest aspect? The front-of-house teams don't need to take on additional work as a result. With the correct software, managing all the specifics of patient access is simple. You can record patient data, confirm coverage and demographics, and prevent any downstream revenue cycle errors.

Recognize payer regulations

In light of possible errors in the revenue cycle, let us examine payer regulations. There are differences among commercial payers, Medicare, and Medicaid in terms of how to submit claims and what codes to utilize. And those guidelines are subject to alter at any time.

Keeping up with all of the payer rule changes can be quite taxing for billers, particularly those employed by large provider firms that service numerous payers. However, it is much simpler to make sure that every claim is being sent to the correct payer and complying with the most recent regulations if you have access to a claims submission tool that understands payer rules on your behalf.

Streamline the payment collection process

Even while it's wonderful to know that claims are filed accurately with payers, patient financial responsibility can still account for a sizable portion of possible reimbursement. The patient may be responsible for paying their co-pay with insurance, or they may not have coverage to cover the remaining amount. In any case, billing teams are responsible for collecting payments from patients.

Offering patients a choice in how they wish to pay is a wonderful method to enhance this portion of the revenue cycle. It's wise to accept payments using credit or debit cards in addition to cash or checks, at the very least. Offer payment plans or contactless payment methods like Apple Pay to improve the likelihood of collecting further payment. Some providers even set up patient payment portals so that clients can pay their amount whenever it's convenient for them, eliminating the need for them to call or come in person.

Automation of workflows

Workflow automation is another popular strategy for enhancing revenue cycle management. This can happen during a number of activities, including payment collection, claim submission and rejection management, and patient access.

Use a coverage discovery tool to find all active payers simultaneously and eliminate the need to contact each payer individually in order to automate patient access. Workflow rules, such as organizing claims by payer type or assigning them to a single biller, can transform an unorganized digital "pile" of thousands of claims during the submission and denial management process into a manageable collection of claims for each individual to concentrate on. Let technology handle the creation of templated patient statements and the mailing of invoices by email and regular mail in order to facilitate patient payment collections.

Automation can be done in a lot of ways during the revenue cycle. Most billing teams merely need to determine which areas of their RCM workflows are most benefiting from technology.

Employee involvement and education

Even with its great value, technology cannot entirely replace the importance of employees. Each employee in the front office and back office has a crucial part to play in enhancing RCM procedures, and they should be aware of this. Staff engagement starts with clearly defining each employee's values and providing them with the resources they require to be successful.

Provide ample opportunity for training and familiarization with the modified processes for each newly automated workflow. Provide ongoing training on a regular basis to support the maintenance of established procedures; these engagements also present excellent chances for additional innovation. Furthermore, assign training as the top priority to all new billers, office managers, team administrators, and other individuals participating in the claim lifecycle. A team will be more productive the more empowered and engaged they are to succeed.

Pay attention to the patient's experience

Lastly, it's critical to keep in mind that the patient always comes first, even when managing the revenue cycle. The RCM process consists of numerous processes that have the potential to either improve or worsen the patient experience.

Printed documents that take a long time to fill out can create a bad impression when a patient is admitted. Rather, allow new patients to pre-register for a visit by completing an online patient portal. This saves time during their appointment and gives them the freedom to submit the information needed for treatment on their own schedule.

When it comes time to collect, provide payment choices and think about purchasing branded healthcare statements that will help patients easily comprehend their debt. Emphasize the need of informing patients about their coverage and expected payments as well, as this may assist prevent unpleasant shocks when it comes to their bills and encourage them to pay what they owe.

Changing your revenue cycle from beginning to end

It is less important to completely overhaul your RCM workflow and more important to determine which aspect of the revenue cycle to prioritize while learning how to enhance revenue cycle management.

The fundamentals of RCM will never change: confirm the patient's eligibility and demographics, prepare a claim using the correct codes, and submit it to the relevant payer. Nonetheless, those phases offer a wealth of chances to create streamlined, more effective procedures that prioritize the patient experience. In an effort to improve revenue cycle management performance, it can be beneficial to automate workflows, provide more staff training and resources, and invest in technology that can centralize many claims and files.