If you've been racking your brain about what revenue cycle management is and how to do it, you're not alone. Health care systems not only in the United States but around the world face the same coding, billing, and payment challenges. While the process is complex, there are steps you can take to crack the revenue cycle management code and improve the overall financial health of your practice.
For revenue cycle management?
What is revenue cycle management (RCM)? Revenue cycle management consists of a series of steps that track revenue to improve the efficiency and effectiveness of your billing processes. In healthcare, RCM is closely related to electronic health record (EHR) optimization, as practice management (PM) software is typically integrated with the EHR.
The prescription cycle begins when a patient makes an appointment and ends when the balance is paid. The entire process is critical to ensuring accurate and timely payment to vendors.
RCM also promotes patient satisfaction by helping to eliminate the frustration of claim rejection and lengthy billing processes. Other advantages of RCM are:
- Damage denial reduction.
- Improved collection rates.
- Increase in total sales.
- Increased efficiency through system automation and redesigned workflows.
One of the main goals of healthcare revenue cycle management is to reduce days outstanding (A/R). Accounts receivable can best be described as sales that have been invoiced but not yet paid.
It is important for the financial well-being of a health system to have a regular income. Too many days of accounts receivable can drastically affect the results. Unfortunately, many healthcare providers and their staff simply do not have the time or expertise to manage RCM in-house, which can result in:
- Reduced reimbursement due to poor coding, training, or workflows delaying or blocking your reimbursement.
- Increased claim rejection due to poor workflow, misuse of data, or lack of timeliness.
- Payments get stuck in accounts receivable due to lack of processes and patient engagement.
- Unoptimized workflows or limited capacity. Staff turnover due to frustration.
What are the 4 main stages of RCM?
Of course, RCM can have a huge impact on your practice, for better or worse. Sometimes it's better to call an expert, but often you can solve many problems with just a few simple steps. What is Revenue Cycle Management can be divided into four steps.
Step 1: Insurance Verification
The first step in the RCM is to collect patient information and verify insurance. To avoid denied or delayed claims, insurance information must be entered correctly. Unfortunately, the administrative team sometimes enters incorrect information, resulting in a delayed refund.
For this reason, third-party insurance verification specialists can play an important role in revenue cycle management. These experts have in-depth knowledge of insurance coverage and policies, coding and billing systems. Outsourcing insurance verification can not only help free up employees for revenue-generating activities, but also reduce days of accounts receivable due to inaccurate insurance claims.
Step 2 – Work with your patient and create a super bill for the patient
Medical Billing and CodingThe information is recorded in the so-called Superbill. A super bill records patient transactions and activities and is the primary source of information for claims. While there is no standard format, Super Accounts are basically a detailed list that aggregates data about the patient, provider, and healthcare services.
What does a Superbill include? Let's start with the patient part, which should include:
- first and last name
- home address
- phone number
- date of birth (date of birth)
- insurance information
When it comes to patient care, the details run deeper and are particularly important not only for claims processing but also for compliance. According to the Centers for Medicare & Medicaid Services (CMS), the HIPAA National Provider Identifier (NPI) is required for administrative and financial transactions.
The NPI is a unique 10-digit identification number assigned by CMS. It must be shared with other providers, health plans, clearinghouses, and any organization that may need it for billing purposes. In addition to the NPI, Superbills must also include the following merchant information:
- Name
- practice direction
- EIN/Tax Identification Number
Finally, for the timely and correct processing of claims, the Super Bill must also include the following information about the services provided:
- date of visit
- Procedure Codes and Description (CPT)
- ICD-10 Diagnostic Codes and Descriptions
- any modifier
- units or minutes
- duty
If all this sounds like a lot of information (and work), we have good news for you. Your EHR should have an automated RCM module to consolidate all of this data into one model to create a comprehensive super bill.
Step 3: Submission of complaints and handling of denials
Denied claims can seriously jeopardize a clinic's bottom line. For this reason, it is important that damage reports are correct the first time. Unfortunately, incorrect claims are all too common. However, most claim denials can be avoided simply by double-checking the claim details for accuracy. Aside from simple typos, there are some general things to keep in mind when filing a complaint:
- out-of-network providers
- dual claims
- Expired or expired insurance.
- coding error
- Lack of prior approval
- Incorrect POS code (service location).
- missed application deadline
- Interventions not covered by insurance
Laut der Medical Group Management Association (MGMA)50-65%of denials are never resolved due to lack of time or knowledge to resolve the claim. There is a lot of revenue at stake, so it is important to have a process for handling denials. The first step is to analyze denials, understand why claims were denied, and identify trends in both the payer and processes.
Practices with limited resources and frequent rejections can benefit from outsourcing their billing. The benefits of outsourcing include:
- Team Focus:They have an entire team dedicated to clearing accounts, checking accounts receivable, and posting payments.
- Supplier satisfaction:Providers can focus on patient care instead of billing and RCM.
- Observance:Third-party experts keep abreast of coding, payment changes, quality programs, and insurance policy updates.
- Precision:Outsourcing reduces errors to ensure claims are paid quickly and accurately.
Step 4: Payment and reporting
Of course, everyone's favorite phase of RCM is when the final payment comes at the end. However, there is another step that is critical to effective revenue management: reporting. Creating and reviewing accounts receivable reports is essential to maintaining good financial health.
Your revenue cycle management software should be able to generate reports that show the current count and balance of accounts receivable, the number of days they are in accounts receivable, and who is responsible for payments. If you see a high dollar amount or the report shows 10% or more unpaid, it might be time to call an RCM expert.
Summary: What is revenue cycle management? Now you know!
In short, optimized revenue cycle management can make a big difference to your query results. You can also make life easier for your staff and patients. Think about our four most important tips:
- Check insurance.
- Collaborate with patients and create a super bill.
- Submit accurate claims and efficiently manage denials.
- Collect payments on time and review trend reports.
Medical benefit can help
If you have questions about your RCM, Medical Advantage can help you. Our process includes:
- Revenue cycle analysis, where we review accounts receivable processes and provide real-time solutions to improve workflows.
- Configure or verify lockout/force close processes.
- Configuration and training for the management of refusals and meeting review processes.
- IE review, configuration and PM audit permission Scheduled task with training.
- Recommend and prepare editions of claims according to the type of practice.
- Database analysis and financial reporting support to identify gaps and areas for improvement.
Understanding the revenue cycle doesn't have to be overwhelming. Our consulting and training services help you create workflows that minimize C/R and maximize ROI and revenue.Contact Usto speak with one of our RCM experts today.