7 Best Practices to Optimize Revenue Cycle Management

Best Practices to Optimize Your RCM

1. Enhancing Eligibility Verification

The contributing factors to an efficient RCM start at the front desk during patient registration. It’s important to have an upfront and proactive staff to check and verify the patient’s insurance eligibility at the start, eliminating the scope of future claim denials.

While your Practice Management Software (PMS) does automatically feed in the patient details, it’s crucial to back this up with manual checks. It helps you ensure the eligibility criteria, identify the services covered, and check for past deductibles.

2. Improving Denial Management

Denial management is where many practices may falter. There needs to be proper documentation and reporting of claim denials for long-term resolution of issues. Documenting and tracking every denied claim helps in identifying patterns and addressing underlying bottlenecks. For instance, if you notice a frequent trend of claim denials due to the same reason, it can help you pinpoint the problem and resolve the issue at its source.

Maintaining detailed records of all denials, helps your billing team promptly spot any trends and take corrective action, such as updating coding practices or appealing decisions. Effective denial management not only helps recover lost revenue but also improves your overall billing accuracy.

3. Regular Tracking and Analytics

Analytics play a crucial role in optimizing your RCM. It’s important to track your KPIs and review monthly reports on claim acceptance rates, denial trends, and days in accounts receivable (AR). This will give you valuable insights into the efficiency of your revenue cycle.

For example, if you notice a spike in the number of claims being denied due to coverage not being in effect, it may be time to revisit your insurance verification process. Tracking the different metrics allows you to identify problem areas quickly and take actionable steps before they significantly impact your practice’s revenue.

4. Having an in-house POC

Having a designated Point of Contact (POC) within the clinic can drastically streamline communication between your billing team and healthcare providers. For example, when the billing team needs additional documentation and information to process a claim, they can quickly reach out to the POC rather than tracking down multiple doctors or staff members.

This systematic process can prevent delays that often arise from miscommunication or lack of response. In order to minimize bottlenecks and ensure prompt claims submissions, it’s important to have someone with authority and a good understanding of the billing process as the POC.

5. Training the Staff

The healthcare industry frequently brings in new coding standards, insurance regulations, and billing software updates. This warrants regular training for your billing staff and front-desk personnel, ensuring that they are up-to-date with the latest regulations, developments, and procedures. For example, relevant training sessions on the latest ICD-10 coding updates can prevent any coding errors that could result in claim denials.

It’s also important that your staff is equipped to handle patient and payer communications, which together determine the efficiency of your RCM. A well-trained team is more confident and efficient, translating to fewer mistakes, faster claim submissions, and improved patient satisfaction.

6. Up-to-date PMS

Modern PMS tools offer automation for routine tasks such as appointment scheduling, patient data collection, and billing and coding operations. However, it’s important to ensure your PMS is up-to-date with the latest tools, compliant with all regulations and has the capability to handle the complexities of your billing requirements.

It’s good practice to conduct a comprehensive due diligence check of different PMS vendors before finalizing one that fits your needs. This process ensures that your system meets your center’s requirements, helping you utilize the latest technologies for optimizing the RCM.

7. Outsource to Billing Experts

Medical billing professionals often bring in a level of expertise and efficiency that may get difficult to achieve internally. The billing experts can help you navigate complex insurance requirements, handle denials, and ensure that claims are submitted correctly and on time.

Outsourcing your medical billing is an effective way to reduce claim denials, speed up reimbursements, and optimize your revenue cycle processes, while your staff focuses on enhancing patient care.

At Lister, our team of experienced medical billing experts help you ensure that your revenue cycle operates at peak efficiency. Our comprehensive services and end-to-end billing support are designed to optimize your billing and revenue cycle, boosting your practice’s cash flow.

Key Takeaway

As noted above, an optimal, high-efficiency RCM results from a combination of strategic in-house practices and assistance from billing experts. It’s important to develop a well-organized flow of processes with a strong reporting and denial management system. The resulting RCM process will help you achieve a seamless billing, claim submissions, and revenue collection mechanism.

If you’re facing challenges in your RCM, or struggling with stuck cash flows, drop us an email today at contact@listerventures.com. Our free mini-audit can help reveal and address the bottlenecks in your revenue cycle and streamline collections.