Best Practices in Revenue Cycle Management

While great care is a necessity—and the core goal—for any practice, a clear and free-flowing revenue stream is also essential for your practice to thrive.

To keep the funds flowing, your practice needs effective strategies and policies for revenue cycle management, including clear procedures for both direct-patient costs and claims submission processes. Without a firm grip on both sides of the dual revenue stream that is unique to healthcare, your practice may struggle to stay afloat in an increasingly expensive and demanding industry.

As healthcare costs rise, a few undeniable trends have also surfaced that are changing the way practices manage payments and patient contributions.

First, healthcare costs are falling more heavily on the patients themselves, even when they are insured. According to HIT Consultant, employee contributions to their own healthcare have exceeded employer contributions by as much as 6 percent over the last five years. High deductibles have also contributed to significant out-of-pocket costs for patients.

Second, technology has changed drastically in the last few years, and legislation from the previous administration started an almost inexorable shift towards heavier reliance on high-tech solutions within practices and hospitals. This trend, while somewhat costly on the front end, could revolutionize the revenue cycle management process–if it hasn’t already in some places–and help practices more effectively manage the patient-heavy shift in healthcare cost responsibilities.

As you build or adjust your revenue cycle management plan, the following best practices, taking into account the trends mentioned above, can help ensure your revenue stream remains steady and strong, despite any major changes in the industry over the coming months and years of shifting government priorities.

The Big Picture

Analyze trends.
One of the first steps in effective revenue cycle management is understanding the financial data through a wider lens. Weekly and monthly reports through your financial systems should allow you to view payment trends over the course of a day, week, month, or year, as well as several years, depending on the data present in your system. Using these and other tools related to data analytics, you can better predict patient behavior and anticipate certain concerns, as well as target problem areas that need your attention.

Identify and resolve problem areas.
Once you’ve set up a regular report schedule or process, which should include weekly and monthly reviews, you can begin to better understand your problem area. A lack of contact information for certain patients, for instance, could be a problem when you’re collecting on a payment plan for a self-pay patient. This information should be verified with every patient interaction, to ensure your team has utilized every opportunity to keep information current. With time, you can identify weaknesses within your practice, places where funding is leaking unnecessarily from your grasp. Upon discovery, you adjust revenue cycle management procedures to prevent further monetary loss.

Aim for transparency.
Transparency isn’t just a buzz word that popped up with the previous administration’s plans to overhaul the healthcare system. It’s a goal that may provide practices with the opportunity to enhance their patient care capabilities and their revenue stream simultaneously. Since, according to Becker’s Hospital Review, out-of-pocket costs for patients grew by 1.3 percent, or $329.8 billion, in 2014, while the overall total for healthcare expenditures rose by 5.3 percent across the nation within the same year, there is no way to circumvent certain patient balances and high out-of-pocket requirements. Your practice can make it easier for your patients to plan for their medical costs by making it clear what the costs will be prior to visits. With this information available, there is a much greater likelihood that patients will be able to cover their healthcare costs and make arrangements for payment prior to receiving care.

Small Steps

While the big picture can help you attain a better overall view, here is the breakdown of small steps recommended by NextGen Healthcare to help your practice resolve concerns and promote efficient revenue cycle management across both the short and long-terms:

Make it financially beneficial for patients with high balances to pay. This benefits both your practice and the patient.
Check eligibility prior to the appointment. Don’t let your patients walk through the door for their appointment until you have a clear idea of what their insurance will cover.
Improve self-pay practices. For patients who are uninsured, be clear and direct about the cost for care, the payment options you offer, and the penalties for not meeting expectations.
Submit claims daily. Never let claims fall behind. Submit your claims daily, submit appeals daily, and troubleshoot on any coding issues that are occurring too frequently.
Establish and enforce clear write-off policies. There are many different types and reasons to write off a balance. Make sure you have a system that is regularly enforced on the books.
Send patient reminders. Phone calls, automated text options, and even automated email options are available for practices these days. There’s no reason you can’t reach out and remind your patients of their appointment and charge a fee for no-call, no-show circumstances. Time is money.
Automate and take advantage of ERAs. Your bottom line will never look better than after you’ve automated as much as possible in your revenue cycle management process. Electronic Remittance Advices (ERAs) are basically electronic claims submission and they can save you money.

Ultimately, there will be other changes you’ll need to make that are unique to your practice, but these are just a few to help you along the way to establishing an effective revenue cycle management strategy that will keep your practice running smoothly for years to come.

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