ISSUE 147: Special Section

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What Are Revenue Cycle Best Practices?

For every physician, clinic, and healthcare organization, the first obligation is to deliver the best possible outcome for patients. Period.

But the truth is, the health of any organization itself is a key determining factor in how well they can care for others in the first place. Best outcomes are a full-circle proposition, from initial visit, through treatment, to communicating with insurance in the billing cycle. An effective revenue engine keeps organizations in the business of helping.

To ensure they receive reimbursement for care, manage denials, and work to increase revenue, healthcare organizations and practices of all sizes follow a process called revenue cycle management (RCM).

Of course, a fundamental truth is that you can’t manage what you don’t measure. Here we’ll discuss key revenue cycle management best practices to consider applying.

7 Revenue Cycle Management Best Practices

When healthcare leaders were asked what they believed the “root cause” of claims denials for their organization was, the majority (36%) answered “missing information.”

Fact is, practices deal with insurance denials daily. But the weakest link in the revenue cycle can often be honest human error. Any number of clerical intake errors, duplicate claims, and lack of prior authorization can set the stage for difficult collection and reimbursement down the line.

While there’s no way to 100% bulletproof a healthcare organization from all claim denials, identifying root causes and having methods for quick resolutions is a great first step. To that end, here are some best practices to consider incorporating.

1. Understand payer fee schedules

Because each payer has its own fee schedule and billing requirements, practices must ensure patients are covered for services, provide proper patient information, and identify any necessary exceptions.

Since they account for much of a practice’s revenue, it’s important to monitor major payers routinely for underpayments. It’s also a good idea to ensure the practice is receiving contracted rates and is prepared to negotiate contracts as expiration dates approach.

2. Reduce claim denials

Practices can work to reduce denials by confirming insurance and verifying eligibility and benefit coverage prior to service.

Be sure to get a copy of the front and back of the patient’s insurance cards for verification and to use valid procedure codes. It’s also important to stay current with new, changed, or deleted diagnosis codes.

3. Prioritize making corrections to existing claims

Not only does correcting claims help the organization see at least some reimbursement for services, it can help create a streamlined process to identify common mistakes for future processing.

4. Be timely and transparent with collections

Inform patients about payment policies prior to care when verifying insurance. If outstanding balances exist, inform patients of them routinely by phone or patient messaging applications.

5. Claim value-based reimbursements

Delivering high-value, highly reimbursable services (such as Chronic Care Management) can improve patient outcomes and increase revenue as well. As more practices move towards value-based care, it’s important to stay on top of billing requirements and other ways to improve processes.

6. Chronic Care Management (CCM)

The Centers for Medicare & Medicaid Services (CMS) offers providers assistance in Chronic Care Management services. This is another way to potentially help increase value-based reimbursements for patients with two or more conditions expected to last at least 12 months.

7. Partner with an expert RCM system

Consider partnering with an expert RCM service to help account managers better handle their day-to-day operations, quickly learn new regulations, and provide insightful analytics.

Vigilant Monitoring for Improved Care

In the end, the task at hand for healthcare is to ensure the highest level of patient care with the most positive outcomes possible. Those seeking care are often burdened with emotional or financial stresses.

By monitoring metrics within revenue cycle management processes, healthcare practices can take the next step to providing patients with more timely, transparent care — from initial visit, to treatment, to billing.

For more about revenue cycle management metrics and how Dean Dorton can help your practice assess their current process, connect with us today. | 502.566.1054