Running a healthcare organization is easier said than done. The larger your hospital, the more complex its operations are. Besides optimizing patient care, revenue cycle management (RCM) is a significant aspect that requires attention. The process tracks and collects revenue from patients, so it is the lifeline of your hospital. Applying best practices to the process ensures maximum reimbursement and high profits for the organization. But you must understand what goes into optimizing the revenue cycle because small steps can make a big difference. Here are some ways hospitals can improve the process.
Stay ahead of accounts receivables
Staying ahead of your Accounts Receivable (AR) enables you to collect timely payments. A healthy cash flow is about minimizing your AR, and you must specifically focus on keeping them under 90 days old. High percentages of AR over 90 days indicate that your practice has follow-up and denial issues. Factors such as staff efficiency in addressing denied claims, ability to collect patient payments, and your payer mix influence timely payments. You can also improve the process by analyzing denials, rejected claims, and contract compliance weekly. Additionally, look for trends and spot the ones you need to avoid in the future.
Verify patient eligibility
Verifying patient eligibility is the mainstay of optimal revenue cycle management. A growing number of patients have to pay at the time of service with the increase in high-deductible and cost-sharing insurance plans. However, most of them are unaware of that fact. The best option for hospitals is to verify patient eligibility in advance. You must also provide them with the necessary information regarding the costs of their appointments beforehand. It prepares them better for bearing the service costs, regardless of their insurance status.
Ensure patient centricity
Improving revenue cycle management for your hospital is also about ensuring that patients are at the center of the process. The mindset takes you a step ahead with better patient relationships and builds loyalty in the long run. You can achieve patient-centricity by providing them with verbal and written explanations regarding their financial responsibility and payment options. Ensuring clear pricing in healthcare is equally crucial as it builds trust for the provider. Remember that your patients should not perceive the medical billing process as intimidating, confusing, and frustrating.
Streamlining your workflows has immense benefits as it allows your staff to focus on high-value activities instead of being tied down to cumbersome ones. Define daily, weekly, and monthly activities according to their urgency and relevance. For example, eligibility verification should be a daily task, while billing is better done weekly. Additionally, your team should enter the reporting activities as a monthly task. Once people know the tasks and timelines, the workflow is better, and the overall productivity increases.
Invest in automation
You can go the extra mile to streamline workflow by investing in automated tools. These tools reduce the workload of your employees by handling manual, repetitive work processes. For example, you can rely on computer-assisted coding tools and revenue cycle management software to manage these aspects efficiently and effectively. Your staff has more time to focus on critical tasks and stays aligned with the organizational goals. Moreover, these solutions facilitate hefty cost savings in the long run.
Prioritize timely filing of claims
Not filing claims in a timely manner is the worst mistake any organization can make when it comes to revenue cycle management. While Medicare provides a one-year deadline from the date of service to file claims, you may get only 90 days from many private insurance companies. Missing these deadlines means the claims go unpaid, and you may even have to write off clinical services. You must implement a process to follow the claim deadlines and ensure meeting them.
Focus on denial management
Denied claims are perhaps the most daunting concern for a healthcare organization because they translate into lost revenues. Monitoring and tracking denials enable you to pick trends and identify the root causes for denials. You must also implement a denials prevention program with standardized processes to mitigate the risk. Ensure your staff knows the nitty-gritty of these processes to follow up claims more effectively. A viable denial management program can decrease denials volume, increase cash flow, reduce A/R, and lower the cost to collect rate.
Optimal revenue cycle management is vital for hospitals as it keeps the money flowing and enhances profitability in the long run. But it can be a lot of work for large organizations with massive daily patient volumes. Following these best practices can keep your process on the right track.