6 Must Follow Strategies to Optimize RCM

Jeff Hough on Nov 24, 2015 7:00:00 AM

In an era where healthcare margins are getting razor-thin and navigating reimbursement policies is trickier than ever, sound revenue cycle management (RCM) practices can help practices and providers lift their bottom line. An efficient RCM workflow and a sound set of policies ensures smooth, reliable billing processes and a higher rate of collection on services rendered.

Providers who want to realize these benefits and stop the cycle of bad debt and non-payment can heed these six suggestions for how to optimize your RCM and remove its biggest obstacles:


  1. Start with Sound Booking Practices

Revenue Cycle Management gets off on a bad foot when patients no-show. Already, you have established a set of services and billable hours that now has to go to waste. There is no quicker way to chip away at the health of your revenue cycle.

Help reduce this bottom line blight by having an automated way to send patients reminders right after they set appointments. Most scheduling system software these days can accommodate services that send automatic reminders to patients in their medium of choice — be it through SMS text, email, prerecorded phone calls or some other form of messaging. This type of service not only reduces the number of no-shows, but it also improves patient experience so that they do not have to go through scheduling twice.

Speaking of scheduling, providing convenient scheduling and appointment-booking options through a web-based system can help you reduce labor spent talking to patients or calling them back. With a fuller booking schedule, you can also have more constant revenue streams and partially make up for any lost revenues on a more consistent basis.


  1. Re-Confirm Patient Eligibility Every Time When Admitting

During your admitting process, patients should be required to present their insurance card or policy number every single time when they turn in their admitting forms. This policy may irk some, but it allows providers to update their systems with the most current insurance information and confirm eligibility with greater accuracy.

Non-eligibility is a major source of claims denials, and practices that render services only to find out there is no payer are going to be putting themselves and their patients in an awkward position. Reduce these sources of tension and unexpected debt by confirming eligibility in advance of rendering services. Doing so can actually improve patient experience by giving them the opportunity to contact their insurer or requesting alternate, covered services.

An automated system makes this process even simpler by scanning the updated insurance information and cross-checking it with the policyholder’s statement of benefits, which saves practices both time and money.


  1. Use Registration as a Time to Collect Past-Due Balances

When beginning the process of rendering new services to a patient, take a moment to check whether or not they are fully paid up for services delivered in the past. Billing oversights, claim denials or a regular slip-of-the-mind can easily lead to past due balances that the patient no longer has at the front of their thoughts. Front house staff can remind them and collect payment or arrange for payment options immediately, opening up a chance to regain lost revenue.

Training for these interactions can involve sample scripts so that tension is diffused and patients receive positive experiences even when being asked to pony up old balances. Sample scripts not only help make front-house staff’s job easier, it prevents patients from feeling victimized, making them more likely to pay.


  1. Consider Revamping Your Billing Statements

A lack of clarity can lead to confusion and frustration in patients, increasing the chances of billing disputes and drawn-out payment cycles. Reduce these incidents with a well-designed document that can clearly and instantly be deciphered while avoiding phrasing that may make patients feel defensive.

Your main billing statement should not read like a car diagnostics report. Create a patient-friendly summary of expenses and balances due sheet to let patients know their full balance and how it can be broken down into categories — such as “supplies,” “copay,” “exam fee,” and so on.

RCM systems can help you with this task by automatically compiling billing statements and printing them out in a patient-friendly format following the latest document design best practices.


  1. Offer Online Payment Portals

Give patients more options to pay while allowing them to visualize and manage their balances more easily. You can even offer incentives for early payment on costs like co-pays or service charges.

The more flexible and accommodating your payment options are in general, the more likely you are to collect owed revenues and have healthier RCM overall.


  1. Reduce Denials through Claims Scrubbing

ICD-10 coding discrepancies, missing information in documentation and other filing errors can lead to instant claims denials. An RCM system that can “scrub” claims for missing or inaccurate fields and flag them reduces the frequency of this problem significantly.

Likewise, having an automated process for auditing denied claims and appealing them can recoup revenue that was supposedly lost. Statistics show that since the ACA was passed, 39 – 59 percent of all appeals resulted in a reversal of denial.


Revenue Cycle Management Does Not Have to Be Painful

As you can see above, a comprehensive RCM software can alleviate most pain points and streamline workflow through automation. Practices that want to stay on top of their RCM and plug up sources of leaking revenue can align their goals by using sound policies in addition to the RCM system features mentioned. Practices that are bleeding money will get a much-needed tourniquet and a suture to help stop gushing revenue problems once and for all.

Author Bio:

Alex Tate is a health IT Consultant at CureMD who provides perceptive, engaging and informative content on industry wide topics including EHR, EMR, practice management and compliance.

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