How to Improve Healthcare Revenue Cycle Management Here are some RCM recommendations such as joining front and back-end functions that can help healthcare organizations streamline their revenue.
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Trends such as value-based reimbursement and healthcare consumerism have changed the way healthcare is delivered and paid for. Revenue cycle management (RCM) is the process of handling claims, processing payment and generating revenue in the healthcare industry. Medical
billing
companies with years of experience in managing medical claims can help providers to meet their RCM requirements, allowing for a steady stream of revenue. The process includes everything ranging from determining patient insurance eligibility and collecting co-pays to accurately coding claims using CPT, HCPCS or ICD-10 codes. Though maintaining a steady income for hospitals is difficult, there are many opportunities to significantly improve your revenue cycle management.
Join front-end and back-end RCM tasks While the front-end staff collects information from patients, confirm insurance coverage and eligibility, and register new patients, back-end revenue
cycle
management
includes
claims
management,
denials
management, medical billing, and final patient financial responsibility collection. When combined, these tasks results in complete healthcare payments. In an article published by RevCycle Intelligence, Rebecca Wright, Vice President of Strategic Planning at the 25-bed Iroquois Memorial Hospital in Illinois has shared her experience on how her organization boosted point-ofservice patient collections by 300 percent by shifting back-end business office functions to the front-end.
This front-end approach to RCM and
patient collections helped the hospital to even exceed a $7,000 per month collection goal for all point-of-service payments, including walk-in visits. The first step that was taken to improve the hospital’s chances of receiving point-of-service payments was identifying the major inefficiencies in patient
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access and RCM. It was found that revenue cycle fragmentation and lack of patient collection understanding prevented the hospital from realizing more patient payments. Also, patient access staff lacked understanding how patient responsibilities were calculated and what was actually needed to process a claim. Steps taken include: Training on patient collection focused on a basic understanding of patient financial responsibility was provided for hospital staff Once staff understood the basics, the hospital worked on breaking down RCM silos by allowing different patient access employees, such as billers, centralized schedulers, and registration staff, to teach their colleagues about their position. Patient education was also provided, as the hospital expected patients to pay for services upfront or make a plan to fulfill their financial responsibility. Improved awareness made patients more willing to make the payments upfront. Along
with
improving
patient
collections
and
enhancing
claims
management processes, the hospital also boosted staff productivity by eliminating 33 hours a month spent on medical necessity verifications. It is also recommended to consider taking suggestions from the frontline staff, as they may have a lot of insight to share and making them active participants in a culture of improvement helps to guarantee sustainable change.
Focus on Patient Financial Responsibility A key component to the front-end revenue cycle is upfront patient collections. More and more hospitals are now setting up programs for patients to pay for their care in advance. As high-deductible health plans increase in popularity, patients are responsible for a significant portion of
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healthcare costs. According to the 2016 InstaMed survey, approximately 74 percent of healthcare providers reported a significant increase in patient financial responsibility in 2015 because of high-deductible health plans. Front-end staff must be trained to educate patients at the time of the visit about what their insurance covers, what they will owe, how to pay, and what services are included. Implementing electronic payment methods can also streamline collections, as patients can log in to online portals and pay their bills at their convenience, thus taking responsibility for their healthcare costs. However, healthcare organizations must take crucial steps to securely store credit card information in an electronic format. More flexible payment options can help patients to pay their large medical bills over time.
Automated Prior Authorization Solutions Insurance verification services and prior authorization support help organizations to reduce denials, minimize delayed payments and improve patient care and satisfaction. Automated authorizations and verification process can reduce administrative costs caused by manual processes, thus optimize healthcare revenue cycles and clinical processes. According to the 2016 CAQH Index, manual prior authorizations cost providers an average of $7.50 per transaction, while electronic prior authorizations only cost $1.89 per transaction. With automated process, staff can also reduce the time it takes to fulfill prior authorization and eligibility requirements and can focus on high-priority tasks, such as patient collections.
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