ALANA WILLIAMS
WHAT IS REVENUE CYCLE MANAGEMENT?
The Healthcare Financial Management Association (HFMA)
defines revenue cycle as "All administrative and clinical
functions that contribute to the capture, management, and
collection of patient service revenue." In other words, it is a
term that includes the entire life of a patient encounter from
creation to payment.
WHY IS REVENUE CYCLE IMPORTANT?
Revenue cycle management solutions play a key role in the
overall success of a medical center by monitoring the financial
stability and activities that keep facilities running smoothly.
THREE MAIN PROBLEMS WITH REVENUE CYCLE
• Staff has not been properly trained or educated
Revenue cycle is like a supply chain; if one person in the chain does their job
incorrectly, it will affect the outcome of the rest of the chain. Incorrect data entry
(insurance information, patient demographics, etc) impacts the revenue of the
office.
• Lack of communication between staff
While the typical office day can be very busy, it’s important that everyone
understands their role in the office’s revenue cycle. Therefore, communication
between the front office, back office, clinicians and the billing team must remain
open in order and is vital to the success of the practice’s financial outcome.
• Poor workflow
Does your staff check patient eligibility and copay amounts before the patient
arrives? Do you check for missing charges against your charge slips? How long does
it take your staff to follow up on claims? Without an established workflow, your
staff can end up missing steps and/or forgetting tasks which ends up in increased
errors and more delays to getting paid.
SOLUTIONS
FRONT OFFICE
• Automated patient appointment reminders reduce no-shows and
help provider productivity.
• Insurance eligibility verified electronically can minimize billing delays
and denials.
• Credit/ Debit card processing of co-pays, deductibles or co-insurance
payments at the time of the office visit increases the probability that
you’ll collect more of a patient’s self-pay balance.
PATIENT VISIT
• An EMR can document the details of a patient encounter, and capture
other relevant documentation that a biller would require to ensure
reimbursement.
• Charge capture functionality can make sure providers input the
appropriate diagnosis and procedure codes at the time of visit to send
to the biller, who can then easily review the clinical notes to be sure
that all codes are accurate
BILLING FUNCTIONS
• Electronic claims can be submitted in real time directly to a clearinghouse.
• Claim status tracking, and claims can be scrubbed before they are
submitted to payers to check that they meet national and local
requirements for medical necessity and comply with commercial claims
stipulations.
• Electronic Payments can be posted automatically to expedite the billing
cycle.
• Key reports can give important insights on both a macro level (e.g. the
profitability of your business), and a micro level (e.g. the profitability of a
particular procedure), and help practices stay apprised of key RCM
indicators
PERFORMANCE IMPROVEMENT
IMPROVING PERFORMANCE
• aTheorem solutions has put together a performance improvement model
that works in conjunction with revenue cycle management
• aTheorem’s practice improvement model hones in on areas such as:
• Right-sizing your staff
• Identifying allocating responsibilities
• Crafting strong job descriptions outlining staff roles and responsibilities
While it sounds simple, strong job descriptions can help counteract and
prevent issues that are directly related to the revenue cycle process
TOOLS AND TRAINING
• Equip staff with the necessary tools and training
For instance, automated insurance verification or
automated appointment booking might help frontdesk staff spend more time interacting with patients
when they present for appointments. The goal here is
to really drill down to fine tune the process and to if
there are any tools and techniques that may be
available to help with that process.
CONCLUSION
• Your reimbursements on claims filed and the money paid out of
pocket by patients are the basis of your revenue cycle. The extent to
which you effectively manage your payment processes and have a
handle on collecting payments that are past due is an indicator of
your practice’s financial health.
• Having appropriate technology, adequate workflow and key billing
processes are important steps on the path toward a prosperous and
efficient practice.