As much as owners and operators of healthcare organizations would like to focus solely on providing the best care for their patients, they must also keep a watchful eye on the efficacy of their billing processes over time. Revenue cycle management is the umbrella term for this essential piece of healthcare; after all, you can’t treat patients very effectively if you can’t keep the proverbial lights on in your practice.
Just like it takes structure to coordinate clinical care, it takes structure to coordinate patient billing. Challenges with the revenue cycle management process range from ensuring all procedural steps are taken, to maintaining clear communications with patients regarding their cost of care, to billing properly and tracking payments long after care has been provided.
How to Achieve Revenue Cycle Management Goals
One key to effective revenue cycle management is avoiding lost revenue due to claim denials and bad debt. Accelerating the amount of revenue that comes in the door and avoiding large amounts of accounts still in the collection process is also critical to a healthy bottom line.
To accomplish this, healthcare organizations should follow some revenue cycle management best practices. These practices reflect three aspects of management in general that are considered pillars of any successful modern business: people + process + technology. Integrated properly, they will help your teams responsible for managing revenue work more efficiently, collaborate more effectively, and identify trends or areas of improvement that prompt proactive measures and strategies.
People
Collect more information upfront
The patient has grown increasingly important as a payer in healthcare today. Because of this, it’s crucial for your office staff to collect as much personal information as possible at the onset of care, sometimes even before the patient arrives for the first appointment. This information provides the foundation for processing claims, and it also dictates how the balance due will be collected from the patient. With clear and effective communication, patients will better understand their benefits and possible treatment alternatives.
Implement staff development programs
Ensuring claims are coded and processed correctly is one important way to reduce denials. Changes occur so quickly in healthcare that providers need to develop employee education programs and require them regularly to ensure proper coding techniques, thorough chart documentation, and financial policy reminders. By reducing medical errors, organizations avoid costly losses or delays, while their staff experiences less frustration which can lead to employee turnover.
Process
Collect patient payments at or before the point of service
While this is often the hardest part of the revenue cycle management process, it remains one of the most critical pieces. Collecting as much of the patient’s overall payment as possible, as soon as possible, is vital to keeping your organization’s money flowing. Determining insurance eligibility and helping patients understand their coverage options is key. This requires building a relationship with patients early to educate them on the insurance process and what their financial responsibility will be prior to care. As medical deductibles increase, more patients need to arrange financing ahead of time to pay for non-emergency services.
Track claims throughout their lifecycle
Just as important as resolving claims denials is identifying the reasons for them in the first place. Insurance eligibility must be consistently and properly verified to ensure accurate billing. Being able to track claims from submission to payment is critical to this part of the process. It enables the recording of claims denials from payers and analysis for trends or common errors that can be corrected to stop repeated incidents of lost revenue.
Keep improving performance
Even if your revenue cycle management is working well, avoid settling for the status quo. Stay proactive and keep pushing for optimum performance that maximizes your cash flow and overall revenue. Establish key performance indicators to clarify your goals and analyze your data; you may be surprised to find opportunities to earn and save a little more just by cutting a few unnecessary costs, decreasing denials, and reducing bad debt and underpayments.
Technology
Aggregate patient data
With the number of changes always occurring to benefit programs and insurance requirements, it will be very cumbersome to manage this information without software that can aggregate all data throughout the revenue cycle. Such technology will provide benchmarks and analytics that feed key insights into your process and enable you to adjust and improve your business where necessary. It will also provide easily understandable financial reports to help your team better understand expenses, how they can reduce costs, and where there are opportunities to maximize revenue.
Consolidate revenue cycle management to a single provider
Managing multiple vendors for various revenue cycle management functions requires extra time and resources. Think about combining operations under a single partner who can provide eligibility verification, claims management, and patient payment processing. One comprehensive system will streamline workflows, increase staff efficiency, and simplify billing for patients, who may then better understand how they can meet their financial obligations.
Offer technology that helps patients pay their bills
In today’s mobile society, a large percentage of patients are on the go and tech-savvy. They respond to products and services that meet them where they are and make their business transactions easy and instantaneous. Offering options like internet-based medical billing, automated reminders, and other digital engagement tools can go a long way toward ensuring patients feel accommodated and motivated to pay in a timely manner.
Home-based Care and Revenue Cycle Management Best Practices
Instituting these practices in healthcare can be challenging, especially in the home-based care industry where profit margins are typically quite slim.
While agencies can pursue these measures to improve revenue cycle management, many within the sector who rely heavily on Medicare reimbursements have an additional contingency outside their control: a requirement by the Centers for Medicare & Medicaid Services (CMS) to get agencies’ patient care plans reviewed and approved by a qualified external provider, generally a primary care physician or other credentialed provider. These providers’ signatures are required before agencies can submit the care plans to CMS for reimbursement, so this often becomes a bottleneck in the process.
In this case, where staff is very limited and the volume of care plans to be signed can easily outpace people to manage them, technology that assists in tracking and automating tasks becomes essential for receiving payments in a timely manner.
Forcura’s Contribution to Healthcare Revenue Cycle Management Best Practices
Forcura is a healthcare technology company whose solutions streamline workflows for home-based care providers and help them optimize revenue cycle management from the onset of care.
With Workflow for Referrals, clients have a robust platform that inserts efficiency and intelligence into patient intake, speeding the process of capturing patient data needed for billing. With care coordination tools, clinicians in the field can communicate securely and effectively with back-office staff, saving windshield time and further advancing the collection of critical patient information in preparation for reimbursement.
With Workflow for Care Plans, Forcura addresses agencies’ signing provider dilemma by organizing and centralizing information regarding care plans and their approvers. Featuring a Provider Dashboard with Follow-up Tracking, the tool enables an agency’s team members to have full visibility into the progress of care plans and take action based on their status. With more automation and strategy involved in the approval process, sent-to-signed times have been shown to improve, opening the bottleneck and stimulating a healthy cash flow.
Check out Forcura today to see how your care teams can better achieve healthcare revenue cycle management best practices to promptly receive the full and timely payments they deserve.
