Unify Healthcare Services
WEBSITE
https://www.unifyrcm.com/
ADDRESS:
353 Middlestone Way Cuyahoga Falls,
OH 44223
5 best practices to have a successful
healthcare revenue cycle management
In a healthcare system, RCM, which is revenue cycle management, is the most crucial
aspect. Through revenue cycle management, one can collect and track revenue from
patients. The process of RCM begins by scheduling a patient for clinical service and
continues till the final payment for the healthcare services has been collected from the
patient that he or she has rendered.
Healthcare revenue cycle management constantly goes through different kinds of
changes. This happens because hospitals continuously merge; they are changing the
payer landscape and acquiring new providers. All these lead to a challenging healthcare
system.
As per a recent survey, it was found out that the biggest threat to the revenue cycle
challenge is the denial rate, which is around 76%. Then comes revenue integrity, which
is 36.8% followed by patient pay, which is 34.2%. With all these challenges, it is quite
apparent for the healthcare revenue cycle management to get caught up and miss the
big picture. To make sure that the healthcare system manages everything well, here are
five best practices that every healthcare organization must follow.
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Tip No. 1: Registration
When there is a high volume of claim denial, any healthcare office staff can feel
overwhelmed. Now, the biggest reason why there are so many denials is that the
representative trying to collect insurance data from patients is failing to collect adequate
and accurate data. This is the most common problem with every healthcare
organization- collecting incomplete, incorrect, and insufficient data from the patients. To
avoid claim denials, give proper training to your call-center staff who collect patient’s
insurance information. They must understand the importance of collecting accurate data
and the repercussions a healthcare industry can suffer if they fail to do so.
At least one week prior to the appointment, the healthcare organization should ask their
financial clearance team to check on the scheduled encounters and verify all the
insurance. While going for a face-to-face registration, make sure to check insurance
cards, along with the expired patient identification. These are just some checklists that
one must follow. Ten minutes spent on the starting phase of the registration will help
you eliminate the challenges.
Tip No. 2: Copay Collection
If your healthcare systems have multiple branches or clinics in different regions, having
consistency with copay collection should be a priority because one might lose traction.
To avoid follow this:
● Try to create an easy-to-understand reference sheet.
● Feed it with standardized documentation.
● Ensure it encompasses the correct copay workflow.
Since there are multiple branches, you need to create a system through which you will
be able to share your monthly copay collection rate report per clinic location.
Tip No. 3: Charge Capture and Coding
One of the highly crucial things for any healthcare organization is to implement and
develop a charge capture process that will effectively capture revenues for every
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service that the patients have taken. One of the most common areas that often suffer or
get neglected is outpatient nursing procedures, such as injections and IV therapy. This
happens when there is a lack of proper nursing documentation training. Even pharmacy
revenue can be lost too when you miss charges or there are some errors in the
reporting units.
It is crucial for both the pharmacy and nursing team to take a good look at their review
chart and understand which charges have been missed and why. They are an essential
part of the healthcare systems, and they must submit correct documents. If it is a
nursing document, then it must include the start and stop time, drugs used, and any
other information, which they feel is necessary. For pharmacies, they must report
dispensing units properly.
Along with this, coding errors, such as upcoding or down coding could be hurting the
healthcare revenue cycle as well. Both procedure and diagnosis codes need to be
updated annually, and taking training on ICD-10 coding could help reduce coding errors.
It is a known fact that entering an invalid code will make a claim be rejected. The best
way to resolve coding errors is to stay updated with the latest version of coding books.
While setting up the RCM system, implanting the coding function to rule out all the
possible errors is important.
Tip No. 4: Timely File Claims
Always file claims promptly. If the healthcare organization fails to do so, they will miss
out on the deadlines. When deadlines aren’t met, the claims that you have received will,
unfortunately, go unpaid. This means that one needs to write off clinical services that
have been rendered. Give proper training to the claim department if you have, and try to
explain the importance of sticking to the deadline. Missing out on deadlines will lead to
challenges; hence, always file claims on time.
Tip No. 5: Customer Satisfaction
A good healthcare revenue cycle management team must think of the best ways to
keep their customers happy and satisfied. Some of the things that one must take into
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account are- how much time has been taken for the claim process to initiate, how about
denial management, AR caller’s ability, how does one deal with patients when they are
resubmitting claims or appeals for a claim, and how about the security of patient’s data.
To maintain a streamlined healthcare revenue cycle management, make sure to offer
the exceptional utility of services.
Wrapping up
Remember the challenges that you can face, and try to overcome them with strategic
planning. These five tips will help you manage a good healthcare revenue cycle
management. If you want to know more about healthcare revenue cycle management,
do contact Unify Healthcare.
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