5 best practices for successful Revenue Cycle Implementation

Revenue cycle management is a term predominately used in the health industry relating to medical insurance claims by the Doctors and Hospitals. The RCM process deals with duties such as:

  • Documentation
  • Data analysis
  • Billing
  • Coding
  • Claim submission
  • Handling denials or appeals
  • Successful approval of claims
  • Submitting the final statements

As the population is growing, the RCM system can become very unorganized and overwhelming to manage. The major challenge for RCM is, how to keep up with the changes of the health industry.Here are the 5 key elements that can create a huge impact on maintaining a successful revenue cycle.


5 best practices for successful Revenue Cycle Implementation

Best Practice 1: Experience and Knowledge of RCM

Hiring a set of well trained professionals is the most important concern of sustaining a productive revenue cycle. Each department must function on different operations such as billing, coding, or handling claims and the person handling this must posses knowledge and proficiency on the role assigned to them.

They should provide high level accuracy and at the same time be aware of time management and also be flexible at managing other operations required in the sector.

While the health industry is evolving each day, clinicians and other care providers should be flexible to the changes and provide the patients with quality care. This view may change the RCM system for the betterment of the future generation.

Best Practice 2: Accuracy

Accuracy plays a crucial part in maintaining the reputation of the RCM company. The two major functions of the RCM are clinical coding and billing which affects the process of attaining the health-care claims. Even a minor fault in these tasks may lead to a huge delay in processing the claim.

Key steps that can help in providing precise accuracy is given below.

The processing of claims can be sent in batches that are monitored in records. This helps in determining any error in a specific batch and can be sent back for revaluation of errors.

Authentication of data and benefits should be done prior to submitting the claims. If any EOB or ERA is received, hospital staff or the concerned person should be notified immediately.

Each patient’s data can be retained, and each claim must be recorded, this helps in documentation and speeds up the submission of claim.

Any changes in residential location or change of employment should be validated from the individual. This is one of the main causes for rejections of claims. Thus by double checking with the individual, the denials can be reduced.

The data of the individual such as general details and medical history must be updated on a timely basis.

The patients must be verified about the payment methods. They may be willing to use credit or debit cards instead of other payment methods. Expanding the payment options can add to an advantage for quicker payment.

Denied claims must be resubmitted with the appropriate feedback. Unpaid or outstanding amount may add up to a huge bill, thus it must be prioritized to close every claim submission.

Best Practice 3: Productivity

Revenue cycle administrative must coordinate with every department to guarantee that the results are of perfect accuracy. They must maintain a solid communication within their own organization departments as well as outside parties such as clinicians, nurses, care takers, hospital registration staff and other revenue cycle organizations.

Communication among the organization plays a major role in improving the overall productivity. IT is a service used in almost all the departments of revenue cycle, so the executives must be well experienced about the modern technologies.

Access to critical data can improve productivity, but at the same time the team must make sure that the protected health information (PHI) is maintained securely.

Best Practice 4: EHR Technology

Electronic health record (EHR) is a compilation of patient’s medical transcriptions and other data in a systematic format. They can be shared among various health-care sectors through a network connection in case of  any requirement. They comprise of the individual’s personal data, their pharmaceutical history and other medical details such as scan reports, transcripts, etc.

They were initially used to increase the quality of service provided for patients. Nowadays they are used for maintaining accurate reports and also to improve quality of results through programming algorithms. By comparison of various types of medical data from the digital files, the specialists are able to identify and provide with the proper therapy for patients. It has also helped in preventing hospitalization of high-risk patients through data analysis of their previous transcriptions.

They are modified to store data and other medical documents accurately and help save time from searching the previous medical reports of the concerned individual. Each person’s checkups are updated in the EHR after every encounter on a timely basis.

The RCM employees must be well equipped with the modern EHR system for managing the patient’s data. This technology helps to manage the documents in a secure manner.

Best Practice 5: Customer Satisfaction

The reputation of a good revenue cycle management team depends upon the customer’s satisfaction. Customer satisfaction depends upon the following:

  • Time taken to process the claim
  • Denial management
  • AR callers ability
  • Dealing with patient appeals or resubmitted claims
  • Security of patients data

A good revenue cycle company should provide exceptional utility of services that helps to process the insurance claim in an efficient way. The RCM company must be aware of the latest trends and technologies in the health-care sector. This will help them to give the right inputs and knowledge to their clients which in turn will build a solid reputation among their peers.

Since health-care industry is one of the fastest growing field in the world, the management of revenue cycle is becoming more and more challenging. The population growth, increases in technology, and elderly population are some of the factors influencing the growth of the health industry.

How to Find the Right RCM Partner

  • Know your priorities well before you go on to search for the right RCM partner for your organization. For example, a multispecialty hospital chain and an independent physician clinic will have separate issues to deal with.
  • Make a quick analysis of the issues you are dealing with and place it before a prospective RCM company to know how they can help you navigate through the losses. Is your company following the best practices mentioned above? If not, how can the RCM partner accommodate the new practices into the existing workflow.
  • While there are different RCM companies to choose from, not all of them are experienced to deal with different healthcare system setups. If you run an urgent care facility, a leading RCM company specializing in dental and vision services will not be of much help.
  • Read through the client testimonials to understand how the company has fared in the past and how they can help you stay updated with the latest changes.
  • Most healthcare systems struggle while adjusting with the new workflow management put forward by the RCM partner. Make sure they have a good customer support team to help you out during the transitioning phase.

The revenue cycle companies must keep in mind about the challenges they are facing due to the above mentioned factors and try to overcome them by providing high integrity of production, being an efficient communicator, having a strong desire to succeed, and focusing towards quality results.

Comments are closed.