Healthcare has experienced a lot of upheavals over the past year and a half. The pandemic has thrown up new challenges for Revenue Cycle Management. With healthcare services stretched in many directions, getting billing and coding services right every time is all the more important.
What are some of the challenges with healthcare Revenue Cycle Management?
The financial challenges of 2020 will continue to have a lingering impact into 2021. One study of the financial impacts of last year on physician practices showed that, on average, practices experienced a 32% drop in revenue during the pandemic. This means many are operating on thin margins, and recouping as many costs as possible in the year ahead will be so important.
Many practices are struggling with the same healthcare Revenue Cycle Management challenges as they were last year. Denied claims, human error, failure to pre-check patients before appointments and coding and billing errors are still affecting the revenue cycle. The difference is, many healthcare providers are already stretched too thin.
Practices can make significant changes to their revenue cycle management to stay on top of their revenue goals. Administration staff can prioritize getting the correct patient information at the beginning of the patient interaction. It’s also essential for practices to process claims carefully to reduce the number of denied claims.
What are the basics of healthcare Revenue Cycle Management?
There are seven steps to healthcare Revenue Cycle Management. At each step, processes can be implemented to ensure that errors are reduced, and revenue is recovered.
- Pre-registration: This step is the most important. If medical practices capture demographic information, insurance information and eligibility information correctly from the start, there will be fewer errors in their patient and payment data. Discuss the financial expectations with your patients, including the timing of payments and your cancellation policy.
- Registration: During registration, the administration staff must ensure that the information your patients have provided you with is correct and has been entered into the system properly. During registration, the provider can collect co-payment or ensure a referral to treat the patient is in place.
- Charge Capture: During this stage, the patient’s financial information goes to the billing side, either through an automated process or through manual entries. Automated systems reduce the number of errors and reduce the double handling of data. Making sure that ancillary services are charged for can prevent money from being left on the table.
- Claim Submission: After charges have been entered, the information is sent to the insurance carrier. The revenue cycle team will look at the charges and codes and make sure the diagnosis supports the procedures that have been performed. Claim scrubbing is the procedure of making sure claims are clean and going through correctly. If a claim gets to the insurance provider correctly, it will be paid faster, and your practice will avoid having a claim denied.
- Remittance Processing: After claims have gone out, you will receive a remittance back which shows which claims for the services you have provided have been reimbursed. If the claim is rejected, providers can review the codes and submit a corrected claim.
- Insurance Follow Up: After the payments have been made, practices should look at what claims were paid and what hasn’t been paid.
- Patient Collections: The best way to get paid by patients is to collect payments when they are in your practice. Front desk staff should be trained to collect at the time the service is provided. Alternatively, patient statements should be sent on a routine basis to help accelerate your cash flow.
What are the Front-End Steps of Revenue Cycle Management?
The front-end steps of Revenue Cycle Management are generally the steps before a patient receives their treatment. Having an efficient front-end process can reduce the number of claim denials, late payments, and errors from occurring.
Start by ensuring your front desk staff is highly trained in patient management. Patients have higher expectations for their healthcare experience. They expect it to be seamless and less stressful, and when they don’t get that experience, they are more likely to switch providers.
To reduce patient dissatisfaction, ensure staff is trained in appointment scheduling, insurance eligibility verification and authorization, and upfront collections. Treating patients like a priority will make them feel well cared for and increase their levels of satisfaction.
How do Revenue Cycle Services fit into Health Systems?
Revenue cycle services affect all stages of the health system. It starts even before a patient has booked an appointment, is part of the cycle of checking that the patient had the right services given to them, and finishes with payment of services, or recouping costs from the insurance companies your patients are covered by.
Since revenue cycle services affect so many parts of the process, it’s an important process to get right. An outsourced Revenue Cycle Management vendor can help your practice reduce errors, recoup costs, and get paid on time and more frequently. Having a healthy Revenue Cycle Management system is critical to the success of every practice.
What are the benefits of Outsourcing Revenue Cycle Management?
Outsourcing Revenue Cycle Management has two main benefits; reducing errors — whether they are in billing and coding, or incorrect patient information— and freeing up your staff so they can spend more time focusing on patient well-being. Both of these factors bring in revenue, first by plugging the gaps in your revenue cycle, then by recuperating lost costs, and finally by creating an experience that ensures your patients are well cared for and will return. Bikham Healthcare offers a complete end to end revenue cycle management service that will recoup revenue you previously thought was lost. With less time spent on revenue management, you’ll have more time to spend focusing on your patients. Bikham Healthcare has years of experience with medical billing and credentialing applications, enabling your practice to get a quicker turnaround.
