7 RCM Steps for Improving Financial Performance
One of the top priorities in a healthcare firm is revenue cycle management. The provider companies, however. Lose $1300 on average per day as a result of incorrect billing practices, according to recent reports like the one presented by the credit agency Equifax. Large-amount bills are more likely to have these inaccuracies. Revenue leaders believe that, in addition to using cutting-edge technology and changing workflows, the staff should update the fundamental RCM procedures to Improving Financial Performance.
While healthcare organizations struggle with a staffing deficit, the in-house billing team needs to be properly led from the ground up to handle the enormous volume of medical billing that is born every day, especially with the resumption of elective care following the spike in the Covid-19 wave. The seven essential stages, which have been outlining in this article, should be carefully heed by your billing staff. Find out more by reading on.
Registration of the Patients:
- One of the most important financial management processes is enrolling patients in the clinic or hospital’s computer system. If done correctly, this process can be rewarding at every stage.
- The administrative staff gathers information on the patient at this stage, including their demographics and insurance information. They must also use the clearinghouse to confirm the patient’s eligibility.
- The accounts manager will receive precise information on the patient’s insurance, such as coverage, co-insurance, deductibles, and co-payments, once the clinic has received all of this data.
- A conflict between the doctor’s office and the insurance companies frequently results from pre-authorization. A step that is still very important in the medical billing process. The billing team must concentrate independently on receiving the authorization on time and with the proper paperwork.
- In the pre-auth stage, the payer office or the insurance provider decides whether the patient genuinely requires a particular medical procedure, a prescription pill, or a set of sophisticated lab tests. It serves as a method of screening for the payers to see whether the patients are receiving fair treatment.
- However, the surgery takes a while to complete and is also bent down, which causes a disagreement between the hospital and the payer. To ensure that this procedure goes smoothly, the billing team needs to set aside different hours.
- Charge capture is the first RCM phase to take place after the patient has received treatment for their ailment. It is also the third stage overall. Prior to beginning any actual treatment, all other crucial processes—such as pre-auth and patient registration—take place.
- The coding team goes over the medical procedures and the doctor’s diagnosis before recording the charge and entering the codes for the treatments that were provided. A procedure’s high complexity and need for improvisation are also mean by the use of modifiers in this context.
- To ensure that the reimbursement is born correctly, the coding team must stay up to date on the most recent modifications to the coding requirements provided by the CMS. Automation software is also use by health systems in this instance to streamline the function.
Submitting Claims to Payers:
- Even though it only takes one step, claim submission is the most difficult and demanding of the RCM procedures. The billing team uses the codes that were provided by the coding team to create the final bill that will be paid for by the payers.
- So that they don’t end up building up on the follow-up stacks, a competent team will ensure that the claims are accurate from the get-go. In order to properly scrub the claims and remove any incorrect demographic information. Misplaced codes that could cause the claim to be rejected, take a number of precautions.
- Following that, the final claims get to the clearinghouse, where they are then forwarded to the various payers. To make sure that there are no problems with reimbursement. It is essential to double-check patient coverage information and other data before submitting it.
- One of the RCM phases is payment posting, which completes a cycle in the reimbursement process. However, in order to identify where the reimbursement amounts could be maximize. It is important to look at the explanation of the benefits.
- Receiving raised claims, reviewing the specifics, and deciding how to repay are the insurance companies tasks. The reimbursement is correct in the patient’s account as soon as the billing team receives it and the explanation of the benefits. Many now use just digital methods, while some still prefer to do it by hand.
- The billing team must carefully read the EOB in order to comprehend why their reimbursement requests were denied. How they can submit those claims again with the required supporting materials to receive payment?
Accounts Receivable Follow-up:
- One of the trickiest RCM stages is checking in with the insurance company to see how the receivables are progressing. The amount owed for reimbursement when left unattended for an extended period of time results in aged AR that is challenging to retrieve.
- Healthcare firms require well-equipped billing teams that can quickly follow up with the payer’s counterpart on a regular basis. They must also be able to present a strong case supported by thorough research.
- To ensure that the healthcare organization’s cash flow is solid and that reimbursements arrive quickly, experts at top RCM companies have a wealth of knowledge in lowering days in AR.
Collection from Patients:
- The practice of “balance billing” patients is no longer rehearse. but the billing staff still gets in touch with patients to request the necessary co-payments and deductibles once the insurance carriers process the claims.
- It is wise to have a uniform policy of collecting money from patients while they are at the medical office due to the increasing burden that people are under to pay their deductibles. Additionally, RCM experts advise that in order to ensure a hassle-free collecting process. The financial expectations should be define at the time of patient registration.
- Another procedure used by leading practices is providing patients with monthly account statements for examination. So that they do not receive any unexpected invoices that are challenging to collect, this beneficial practice keeps the patient in the loop.
RCM measures you should take to enhance your Improving Financial Performance. Please get in touch with us in the comments area if you have any questions. We invite you to subscribe to our blog and follow us on LinkedIn, Twitter, Instagram, and Facebook. For more articles of this nature about the medical billing sector, technology, and Improving Financial Performance.