The process of Revenue Cycle Management does not solely depend upon medical billing and coding. There is a lot of streamlining that is involved in the work process in order to achieve proper revenue goals. HFMA (Healthcare Financial Management Association) interprets the process of revenue cycle management to be all-inclusive clinical and administrative functions that help in the capturing, managing and collecting of the required revenue from the patient services.
In easier terms, RCM can be referred to as the financial process which is the result of the clinical encounter from the patients. Healthcare Financial Management Association says that the rudimentary role played by the RCM is measuring the maximum amount a healthcare organization bills a patient on the services that have been provided to them. While the primary focus remains on processing the claims, generation of revenue and fulfilling timely payments, the inclusion of patient services and how it directly impacts the entire reimbursement process is quite crucial as well.
Ways To Improve Revenue Cycle Management
If you want to focus on maximizing the revenue earned by your organization there are certain things that must be considered. These are everything you should know when you want to improve upon the revenue cycle of your organization.
- Coding and Charge Capture: Improving the process of charge capture, it is crucial that the administrative staff of the medical organization focus on clearly communicating the procedures and policies to the patients and the patient party. The suspense times refer to the strict timelines which get placed on the clinical departments. It is crucial to remember that every day when the charges do not get entered and fall out of ‘suspense’ can lead to a negative effect in the outstanding AR along with the cash flow. Methodical reviews of the CDM (charge description master) are key that ensures the hospitals are collecting the necessary revenue in a correct manner.
- Filing the claims in a timely manner: Medical organizations who hire revenue cycle management services often fail when it comes to the filing of the initial claims or even responding to the claims appeal due to unmonitored or inefficient processes. This leads to missing out on the deadlines. Commercial payers have to submit the claims within a span of 90 days whereas the initial claims must be submitted within a year of the date of the service. The time span to respond and appeal to the claim denials is up to 120 days whereas for commercial payers it is up to 90 days to a year depending on the guidelines.
- Collections and billing: Depending on all the methods that are involved during medical billing, medical organizations can expect to receive the reimbursement within a minimum of 15-day period. If the turnaround time is more than a period of 30 days from the day the medical claim has been sent out, the revenue cycle management company needs to do a medical claim follow-up.
A proper follow-up process will help in decreasing the total days the medical claims have been outstanding. The majority of the time rejections are a result of medical errors that tend to occur during filing the claims. Healthcare revenue cycle management should work on the claims to prevent further rejection in the future.
Denial management: When it comes to the claim denials they must be monitored, tracked and reported since these three are the core components that make up successful claims denial management. The identification of the trends and understanding the root causes of these claim denials are key steps when it comes to implementing a proper revenue cycle management strategy. Medical billing companies in the US tend to practice certain things that help in the overall revenue generation – they make sure to monitor KPI and also convey the claim denials to the departments.
Some of the best denial management practices can help in increasing the overall cash flow, reduce the accounts receivable, expand the number of clean claims, lessen the claim denials and also lessen the total cost collection rate. Some of these include:
1. Analytics and reporting tools that help in monitoring the crucial details that have been outlined.
2. Clearly explained procedures and policies about the tracking, identification and reporting of all the claim denials.
3. Reporting the management team in relation to the denial analytics, training and education plan along with the initiatives for process improvement.
4. Meetings to discuss with the interdisciplinary team will help to understand the trends that occur during the claim denials and how to stop them. Understanding the root cause for denials will help in gaining insight.
5. Training and educating the staff that focuses on the systematic process will help in mitigating the claim denials risk.
RCM KPI (Key Performance Indicators): When it comes to the revenue cycle, being dependent upon KPI and focusing on proper management is important since it helps in accountability. It is difficult to understand and track the KPIs of the revenue cycle if you are not continuously updating and benchmarking the performance levels. For instance, if the goal of the organization is to lessen the days in AR by 10% within a span of one year then they must have a scoreboard or a dashboard that will show the current days in the AR along with the early values that will help in the determination of the current efforts.
There are many KPIs that RCM services tend to use in order to reimburse the entire payment to the medical organization. RCM companies tend to ensure that the profit earned is consistent which helps in the growth of your organization.
The backbone for any medical organization is proper revenue cycle management (RCM). They help in ensuring that any medical organization stays financially stable in the long run, and this is where a company like Synergy HCLS can help you out. The implementation of the process that has been mentioned above requires a group of adept individuals who are experts in the field of medical coding, billing or any other revenue cycle management functions.