Applying best practices to the revenue cycle ensures maximum reimbursement for services offered. While clinicians document the services they render and the supplies they use, many are not aware of how much revenue they are leaving on the table with inefficient revenue cycle management.
Best Practices to Improve Revenue Cycle Management
Putting the patient at the center of the process
Healthcare practices that maximize revenue cycle management understand the need for better patient management relationships. The practice will build a positive relationship with its patients if the staff works to improve patient satisfaction.
The staff should provide the patients with verbal and written explanations regarding their financial responsibilities, Payment methods, and what to expect from their visit.
The medical billing process is intimidating, frustrating, and difficult for some patients and the more interaction they have with the staff, the more likely they will reimburse the provider.
Investing in Technology
If a patient fails to invest in technology to keep up to date with payer requirements and diagnostic codes, they will end up getting less than what they should be reimbursed with. It is time-consuming and costly to investigate unpaid claims, correct mistakes, and resubmit them.
Automated software will alert a patient of medical coding, billing and point out errors that have to be resolved before claims are submitted.
Collecting Patient Financial Responsibility before Services are Rendered
If a patient's financial situation is underpaid, the health practice risks never getting fully paid for their services. In this case, additional staff must be employed to follow up with patients and collect.
Healthcare practices should collect deductibles before rendering their services.
Automating Prior Authorizations and Eligibility
Verifying insurance coverage is the first step of successful revenue cycle management. Insurance companies are creating stricter requirements for prior authorization and coverage eligibility.
Automating prior authorizations and eligibility can help optimize clinical processes, speed the revenue cycle and reduce time spent on this task.
Improving Charge Capture and Coding
Hospitals and healthcare practices need to develop and implement processes to capture revenues for services rendered efficiently.
Areas that experience lost revenue are outpatient nursing procedures like injections due to lack of proper nurse documentation.
The other area is the pharmacy. Pharmacy revenue is lost by missing charges or errors in reporting of units. Nursing and pharmacy units should review charts and claims for missed charges.
They should submit proper documentation and review pharmacy charges regularly.
Timely Filing of Claims
Many organizations do not file claims timely and miss filing deadlines. If deadlines are not met, claims will go unpaid and the practice must write off clinical services. There should be processes in place to ensure deadlines are met.
When all the above processes are not followed strictly, the end result will be denied claims. Monitoring and tracking denials are critical for any medical practice. This is done to identify trends and discover their root causes.
A denial prevention program should be implemented to mitigate the denial reasons.