The Most Effective Method To Further Develop RCM To The Greatest Potential

As healthcare organizations shift towards value-based care models, mastering revenue cycle management (RCM) has become more critical than ever. Healthcare facilities face growing challenges, including increased patient responsibilities, fluctuating insurance markets, and rising claim denials. This article outlines nine effective strategies on how to improve revenue cycle management, ensuring healthcare providers can maintain high-quality care without compromising financial stability. These tips range from leveraging RCM software to improving patient interactions, all aimed at streamlining the financial aspects of healthcare delivery and the revenue cycle management processes.

The 9 Most Effective Methods to Improve RCM

With the healthcare industry transitioning from fee-for-service models to value-based approaches to control rising costs, RCM and revenue cycle improvement have become even more significant. From pre-registration to collections, the effectiveness of your revenue cycle depends on several key factors. Your clinic or healthcare institution may be dealing with largely external forces, including patient debt, reduced income, and increased claim denials from an unstable health insurance market. How can you improve your RCM in the evolving healthcare environment without compromising care quality? Here are nine strategic and practical solutions:

1. Utilize Revenue Cycle Management (RCM) Software

Automated RCM services can streamline and automate processes, maximize profits, and even provide insights into patient populations, such as illness rates, frequency of visits, and ability to pay. Integrated with other health IT systems, including electronic health records and medical billing, effective RCM software shortens the time between service delivery and payment receipt. It can also assist with tasks like scheduling appointments, reminding patients of outstanding balances, and responding to payer claim denials with queries and appeals. And finally, it can indicate areas of lost revenue from things like the billing process, patient payments, and more.

2. Increase Pre-Admission Contact

Time spent with a patient before service can significantly impact operational efficiency and financial savings. Calling before an appointment to clarify copays and payment methods and even collecting payment over the phone can often improve cash flow. Pre-admission contact also prevents confusion about information updates and insurance changes at the registration desk. It allows patients to ask administrative questions before the service, improving patient loyalty and satisfaction, as well as the overall patient experience.

3. Put the Patient First

Foster strong provider-patient relationships in every interaction—from initial contact and registration to service and collections. Satisfied patients are loyal, and focusing on convenience, care, and accountability as a provider will lead to prompt payments and word-of-mouth referrals. Going the extra mile for patients to enhance the revenue cycle may include offering more payment options (e.g., credit card, debit card, check), prominently displaying available payment methods at registration, providing small tokens of appreciation (e.g., a pen, keychain) when payment is received in person, or giving patients more insight into their upcoming services or procedures.

4. Streamline Registration Desk Processes

Small workflow changes can lead to significant improvements in team performance and faster returns. A checklist at registration for staff to follow when copying insurance cards and verifying patient identities is essential—much like pilots use checklists to ensure safe flights. Overseeing claim submissions, or "cleaning" claims, can help prevent common errors such as incomplete plan information, coding mistakes, patient ineligibility, and missing supplemental attachments—errors that would otherwise lead to denials and disrupt your workflow.

5. Regularly Review Payer Contracts

Tracking errors in reimbursements, claim denials, and payments can consume a great deal of time for multiple employees. Regularly reviewing payer contracts can help identify discrepancies, monitor trends, and open discussions with payers about any issues affecting provider relationships. Combined with data analytics from an RCM software system, contract reviews can help determine why certain claims are denied and develop steps to improve the process.

6. Eliminate Post-Service Costs

Imagine not dealing with billing, collections, reminders, or bad patient debt after services are rendered. Is that even possible? Absolutely. Eliminating post-service costs can be as simple as collecting payment upfront before services are provided, either through pre-admission contact or at the registration desk. When your registration desk verifies insurance, they can also collect payment, confirm patient information, and verify contact details. Post-service patient satisfaction surveys may also reflect this more efficient process, reducing the likelihood of negative feedback after a confusing and drawn-out payment process.

7. Offer Digital Solutions to Patients

An online patient portal that allows patients to track appointments, pay bills online, monitor their health records, and keep results in one secure yet accessible place is essential to streamlining the revenue cycle in the digital age. Patients expect to be able to pay bills online with a credit card and print out admission forms before their appointment. The less time they spend in your office, the better. Faster service doesn't have to compromise quality, and removing obstacles to save staff time and waiting room space can also increase patient volume.

8. Automate Eligibility Verification

Forget calling, faxing, and browsing payer websites to determine a patient's coverage type and level. An electronic eligibility verification system can provide a one-stop solution to a time-consuming task, speeding up registration and payment processing, and giving staff more time to handle more complex issues.

9. Communicate with Frontline Staff

Regularly reviewing processes and workflows with frontline staff will help you promptly address any issues they face, learn about their workarounds, and even resolve longstanding problems. Their suggestions and feedback from daily frontline experiences are invaluable, and combined with data and patient insights gathered from RCM and enterprise analytics software, you may be able to help management implement better claims, billing, and collections strategies.

Revenue Cycle Management with PayrHealth

Improving the revenue cycle in healthcare is a complex process that involves both technology and human interaction. By incorporating advanced RCM software, enhancing pre-admission contact, prioritizing patient needs, and regularly reviewing payer contracts, healthcare facilities can significantly improve their financial operations. These strategies not only ensure smoother financial processes but also enhance patient satisfaction and staff efficiency. Ultimately, adopting these practices leads to a more robust, efficient, and patient-centered healthcare system that is capable of adapting to the changing dynamics of the healthcare industry.

Contact PayrHealth today to learn more.

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