How to Make Your RCM Go from Zero to Hero

Revenue cycle management is a major part of a clinician’s journey in healthcare. It affects their performances if there are unnecessary delays in the claim submission process as each step of the process has to occur in a timely fashion for revenue optimization.

Practices should foresee every step carefully to ensure fewer denials and a smaller pile of accounts receivable.

As a guideline, we have come up with six foolproof revenue cycle management tips to ensure a hiccup-free process all the year-round.

1. Efficient Denial Management

If hospitals or individual physicians let accounts age in their receivables, six months can quickly pass by, and practices can lose the right to appeal by then. Hence, it is better to keep an eye on accounts receivable because to undergo accounts receivable (AR) management is to optimize your revenue cycle permanently. RCM process is the backbone of practices, and it should run seamlessly. To support a healthy RCM process, practices must address their accounts receivable and keep it to a minimum.

Whether you hire medical billing services to look after your payment process or keep an in-house team to optimize results, reimbursement is what keeps you going. To make it a stress-free phenomenon, it is advised to keep your denials under strict supervision. We don’t want your insurance billing to face uncalled for disturbances.

2. Report the QPP MIPS Program – For Eligible Clinicians and Opt-ins

In MIPS 2020 reporting, the performance categories remain the same with unaltered weights. The scores in Cost, Quality, Promoting Interoperability (PI) and Improvement Activities (IA) have an impact on the total score. It is important for eligible clinicians and those participating in it based on the Opt-in policy to accurately report data as the MIPS program has a huge impact on their revenue cycle.

The date for the current QPP MIPS program closes on March 31, 2020, for the PY 2019. All data that needs to be reported to CMS has to be accurate and requires meticulous submission. The data from the four performance categories are aggregated into a final score based on which CMS evaluates a clinician’s authority. They receive bonus impacts of up to 5% for reporting MIPS 2019 via P3Care.

3. Verify Benefits and Health Plans for Current Patients 

We are at the start of 2020; each year the insurance benefit deductibles are reset. It is time to revisit insurance plans and benefit levels of your current patients. Such verifications should include copay, deductible, and coinsurance checks. To get it done seamlessly, establish protocol like a 72-hour verification period protocol in your practice.

Before the patient’s appointment, verification of benefits prepares the staff, and, in turn, lets them assist patients to pay upfront costs. The window of collecting payments from patients gets smaller once they leave the doctor’s office. Therefore, it is fitting to collect them on their visit.

4. Invest in Good Employees

All the stages of a revenue cycle are crucial; however, investing in good employees is always a good move. As healthcare IT specialists, we recommend a few but vigilant staff to work your accounts.

You can gauge their vigilance by the pile of accounts receivable; if it is comparatively smaller than what you had before, you are definitely among the right people. Hire energetic; people who do not rest until the job is done.

Even if you have to pay them over the average salary range, pay them as their presence is beneficial to your business.

And for those laid-back employees, consider moving them to areas of your practice that suit their strengths.

5. Continue to ask the “Why” behind Claim Denials

When we raise these questions in case a claim is denied, it creates room for us to fix our mistakes. As revenue cycle directors, we want to bring denial rates down and increase revenue. Nevertheless, examples of clinics in terms of their revenue cycles stand up as learning modules for other practices.

Practices have to it a habit of running audits as such audits monitor staff productivity and make sure they don’t leave unfinished processes. Eligibility verification and registration are elements that can’t be ignored in an RCM process. Moreover, practices should particularly focus on training staff in the eligibility and registration phases of the revenue cycle to stop unnecessary denials.

Part of staff training should include how to identify inactive insurance; the use of the eligibility tool; checking of primary insurance; and how to collect co-pays at point-of-service.

Patient experience is pivotal in 2020; QPP MIPS is one of the ways in which value-based care shapes the future of healthcare. It bases its ideology on quality care with fewer expenses. When the cost of care is less and the quality is high, patient outcomes automatically improve. We must give the most weight to patients because the system stands on them. It is their welfare that counts the most.

6. Educating the Patients

Patients are there to get well.

What on earth can we educate them in?

Well, we can educate them on the separate billing process.

A poster in the waiting area about the process would be helpful. Nevertheless, at the point-of-service, staff should educate them about separate billing invariably to unburden them of the payments.

While things are communicated to them in person, a handout that explains separate billing is actually beneficial to future payments. It must be easy to understand with pictorial representation of the steps where necessary.

Do not be bothered by their questions because that is going to bring them back to your practice. The information on separate billing should be visible on your site, on the patient portal specifically designed for them. They are sure to check back on it later.

Final Verdict

RCM in healthcare is the lifeblood of every practice. It is the nucleus that powers day-to-day operations.

The less it suffers the better.

By applying the above strategies, a practice manager can not only make it go smooth but expedite patient access to useful billing material. Patients at the time of care have already too much on their plate, but by the use of healthcare technology in favor of both, we can share some of that burden.

To speed up your revenue cycle management in healthcare; do not forget to search for the top 10 healthcare revenue cycle management companies on Google and select one with a greater number of good reviews.