Having a healthy revenue cycle is the key to a successful and well established practice. In the long run, for a practice to continue operating profitably and to deliver high-quality treatment to its patients, successful and healthy revenue cycle management (RCM) is crucial. A well organized RCM is what provides financial stability to a practice. Therefore, it becomes important for a practice to allocate top priority to its revenue cycle management.
So, What is Revenue Cycle Management or RCM?
Revenue cycle management, or RCM, refers to the process of identifying, collecting and managing the revenue of a practice based on the services that it renders. The cycle begins the moment the patient makes an appointment and ends when all the payments are collected. There are several steps involved in RCM that should be carried out efficiently to ensure a faster and better payment cycle. Revenue cycle management can be highly difficult and complex, therefore requires a great deal of effort from the side of the practice to learn and understand the various processes involved. Any inefficiency in the management can disrupt the full functioning of the practice and can reduce the revenue flow. Identifying and rectifying the mistakes in RCM could be the best way to minimize the loss in revenue for your practice.
Here are some of the common mistakes in RCM
1. Inaccurate and Incomplete Data Collection
Accurate patient information collection is very important for strong revenue cycle management. If any errors or inaccuracies occur, then claim denials are bound to happen. Therefore, make sure that you have accurate and complete patient information and data. Double check the information collected before submission to make sure that all the information recorded is complete and correct. Remember, a lot of claim denials happen because of such errors in patient information and data collection.
2. Not staying up-to-date with insurance regulations
The practice needs to stay up-to-date with the frequently changing insurance rules and regulations to produce clean and successful claims. If your practice is not updated with these insurance rules, then there are more chances of mistakes or errors prompting denial of claims, which in turn may reduce the revenue of your practice. Not following through on this can create a lot of difficulties in the proper working of the practice.
3. Late Submission of Claims
Delayed claim submission is one of the most recurring reasons for claim denials. A delay in claim submission can disrupt the entire revenue cycle process, thus delaying the full payment process. It greatly hits the revenue of a practice and can create a lot of hassles. Remember, late submission of claims can make your already complex revenue management process even more difficult. Therefore, it’s better to submit your claims within the given time frame to avoid unnecessary trouble.
4. Inefficient denial management
Denial management is one of the most important steps in the proper management of the revenue cycle. Effective denial management could greatly help in increasing the revenue of your practice. It happens quite often that the practice pays less than necessary attention to its denial management without realizing that it could actually impact their revenue. It is no secret that claim denials can lead to the leakage of revenue, impacting the entire functioning of the practice. Therefore, reworking and resubmitting denied claims on time should be of top priority in a practice.
5. Bad patient eligibility and benefits verification
Many practices, often in a hurry to submit claims within the given time frame, pay little or no attention to proper eligibility and benefit verification of patient insurance. It may seem like a small thing, but it can have a huge impact on the revenue production of your practice. This is one of the most crucial and important steps in the process of RCM and any mistake or carelessness in it can in turn lead to easy denial of claims. So, remember to be careful in your patient eligibility and benefits verification processes.
6. Slow Accounts Receivable Follow-Up
It’s no secret that the larger the number of days in AR, the higher the risk of payments going unpaid. Therefore, the more time you take on accounts receivable, the greater the revenue cycle gets hit. As a result, accelerate your AR follow-up for better and faster revenue cycle management.
Here are some solutions to these common mistakes
1. Tracking of claims
Efficient tracking of claims could be the best way to avoid any mistakes occurring in your RCM. Always keep track of your claims to know if any claim denials occur. It also helps you in determining the reasons for claim denials, so you can take steps to prevent the same from happening again. Tracking claims helps you prevent recurring mistakes in claim submission that cause denials. Make sure to track your claims until you receive your payments.
2. Proper patient registration
Do proper patient registration before providing the services to avoid any mistakes in patient documentation and the submission of claims. As earlier mentioned, any errors or inaccuracies in the information collected can lead to claim denials. Therefore, it becomes highly important to ensure that you have complete and accurate information on your patients before providing any treatment. This helps in preventing claim denials to a huge extent, thus improving your revenue cycle management.
3. Proper communication with patients and insurance providers
Do not shy away from contacting the patient or the insurance providers if any additional information is needed or any doubts need to be cleared. Maintaining proper communication with them is important for maintaining a healthy revenue cycle. Proper communication helps you stay up-to-date with patient data and information, as well as the changing rules and regulations in insurance payment. It also helps your practice in building trust with the patients.
4. Make the process patient-friendly
Patients are always the top priority in a practice, and they determine the success or failure of a practice, so it’s very important that you provide the best experience for your patients in your practice. So, make your revenue cycle management process as simple as possible for your patients. Make sure that they are updated at every point of the process. Make them updated on the payment process so that no surprises come their way that may lead to them paying out of their pocket. The failure to which, can result in patients losing trust in your practice, which can create a huge revenue loss for your practice and can disturb your entire RCM.
5. Opting for an RCM service provider
Opting for an RCM service provider is the best way to reduce any mistakes that happen while managing your RCM. Handling the RCM is a very difficult and demanding task which takes up a lot of your practice’s time and energy, especially with the limited staff. This could even prevent your practice from giving proper attention to other important needs of your practice, but with an RCM service provider by your side, you can easily focus your complete attention on the more important needs such as patient care as well as the expansion and growth of your practice while letting them manage all your RCM related worries and difficulties. This improves your RCM and, thereby, the revenue earned by your practice.
Conclusion
Improper management of RCM can cost a huge loss of revenue for your practice. Therefore, RCM becomes one main aspect of maintaining a healthy and successful practice.so, always make sure that you have proper knowledge on the various processes related to RCM and how to handle it. Most importantly, remember a successful RCM is critical for the growth and development of a practice.
