13 Steps Of Revenue Cycle Management

Prior to the global pandemic, medical billing was simply something that healthcare organizations carried out in-house. Now, with 75% of American patients intentionally following up on their medical billing cycle online, healthcare providers need to have an efficient revenue cycle management workflow.

Executing an efficient revenue management solution ensures that your organization tracks its money. Thousands of dollars can be lost in patient payments, payer reimbursements, and other streams of revenue that affect your operational costs.

This blog will guide you through the steps of revenue cycle management that will streamline your revenue flow and help you stay on top of your money.

Design Your RCM Work Model

Take the time to understand the entire medical billing cycle from the time of a patient’s appointment to the moment the medical bill is paid in full.

With the right information on hand, you can decide whether or not to outsource RCM services to qualified professional companies or implement RCM software with the features that work for your organization.

Aligning Your RCM Staff

Finding the right model for your organization is just the beginning. The real work lies with your staff members and how efficiently they can adopt the new RCM model.

The success of any financial management system starts with the everyday users on the substrate level. Your staff has to be able to employ the RCM with the end goal in mind: less paperwork with higher returns from payments.

When adopting a new RCM model, make sure that your staff undergoes appropriate onboarding and training that allows them to work effectively.

SmartClinix Medical Billing provides you with a dedicated internal team that’s in constant contact with you and focuses on understanding if the new system is helping your organization increase revenues.

Patient Registration

Getting the right patient information in the initial stages can make or break the success of your revenue cycle management. 

Inaccurate patient details lead to delayed processes and incorrect data, which is crucial for monitoring and measuring the effectiveness of the RCM.

A great practice is to encourage patient pre-registration. This allows for a more meticulous check of patient information and prevents claim denial.

Patient Eligibility Verification

Patient pre-registration, which we discussed in the previous step, plays a crucial role in patient eligibility verification.

A great revenue management cycle plan should limit the patient from paying out of pocket. Cash payments may lead you to lose business.

Your RCM model needs to have accurate and verified insurance details. 

Here are three surefire steps that your staff must follow during the patient eligibility verification process:

• Verify disparities in patient information early on.
• Contact the patient beforehand in case of any discrepancies.
• Always check if patients’ insurance coverage is up to date and flag expired covers.

Prior Authorization

Procedures may require patients to have authorization after providing the necessary proof to support their claim. Your RCM should offer a transformative experience for your patients. 

Automating the process of prior authorizations can make life very comfortable for your patients and encourage them to keep using your services.

Co-payment and Deductibles

Medical Billing services that may need to be paid out of pocket may interrupt the flow of your medical billing system if they are not taken into account.

Get a clear understanding of the medical services that the patient’s insurance does not cover and ensure that you flag such services to them early on.

Like icing on the cake, go further and highlight any deductibles that they are eligible for. This shows that you care about your patient’s finances as well.

Tip: Make this process easier on your staff members by clearly stating the options available to a patient. 

Coding of Services

Coding is one of the most effective ways of ensuring that your services are clear and easy to measure.

Your RCM model should be able to measure various aspects of your services, their popularity, and their shortcomings.

Successful claims are facilitated through a straightforward process, and the coding of services is one such straightforward method.

Follow these three steps to ensure that your coding services benefit you:

• Keep up with any and all changes in the coding guidelines from the federal authorities.
• Keep coders up to date at all times.
• Train staff members regularly on coding guidelines.

Claim Submission

Submitting claim forms on time is just as important as getting the information on the forms right. Ensure that your employees understand that getting on-time reimbursement is part of the success of the RCM system.

Train your staff to double-check claim forms before submission to avoid claim rejection. Data such as codes, claim format, and patient details should be checked meticulously to avoid errors.

Claim Reimbursement

This step solely belongs to the insurance company. Claim reimbursement involves cross-checking all the claim form information against various systems and approving its eligibility.

Most insurance companies will give an explanation for the reimbursement amount, and you can use this to improve the claim submission process in your RCM.

Claim Denial Management

It is crucial to make sure that there is a process to improve upon your claim submission process after receiving a partial reimbursement or a rejected claim.

Having an adequate denial management workflow in place ensures that your resubmission is better crafted to rectify your claim reimbursement on time.

Training your staff to keep time is crucial in this stage as well.

Review for Payment Variances

In case of any variances in your reimbursement, it is imperative that these disparities are later examined and broken down into solutions that can improve the system.

Payment variances can be a result of many factors, including erroneous coding mechanisms and late submissions. 

Keeping account of these details will go a long way in making sure that your revenue cycle management system continues to thrive.

Patient Collections

This has been deemed one of the most crucial stages of any medical billing system. The process of following up with due payments requires patience and diligence.

Having a good revenue cycle management system will aid in providing adequate explanations of the insurance coverage to your patients and encourage payments.

Financial Evaluation

One of the greatest benefits of having an effective RCM is that you can evaluate and adjust your financial goals. This evaluation can lead to improved services and a transparent and beneficial relationship with patients. 

Ensure that the RCM model you put in place provides analytical reports to help you reap the benefits of automating your revenue management system.

For a health facility to prosper financially, especially after most were hit hard due to the COVID-19 pandemic, it is more important than ever to not just have a Revenue Cycle Management System but to adhere to each step religiously.

With SmartClinix Revenue Cycle Management, you can identify the issues in your revenue cycle and adjust it to streamline your billing process. The medical billing experts at SmartClinix will ensure your practice achieves faster cash flow, increases overall revenue, and reduces A/R days!