Three Ways to Keep Up With Healthcare Revenue Cycle Management

As much as healthcare professionals try to keep the focus on patients and providing the best care possible, they have to face financial ebbs and flows like any other business. In truth, they encounter many other obstacles that standard business does not have to deal with, including several more legal requirements and the challenges of working with insurance companies for payment, which all affect practice revenue.

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Such additional challenges make effective revenue cycle management even more important—the more you have to juggle, the more important it is that you learn to perform.

When it comes down to it, providing effective healthcare depends on having a good system of revenue cycle management. Without it, your practice will lack the funding necessary to meet patient needs and to expand on services for at-risk patients.

Good revenue cycle management requires one thing: continuous monitoring. While this may seem too simplistic or, in some cases, too daunting, a strong system for proactive and regular monitoring of your revenue stream is well within your reach.

The suggestions below will help you get your revenue cycle management plan back on track or help you set up an effective system that will ensure your practice receives funding promptly and—most importantly—that you don’t miss out on funds you should have received due to lagging response times or ineffective processes.

Know your weaknesses.

The first step to an overhaul of your current revenue cycle management process is to understand where you might be falling short or where you might have room to improve. To that end, identify each step that your practice takes in managing patient payments (copays or self-pay), insurance claims and denials, and expenditures for necessary supplies. Are there areas of weakness? How much money should have been collected? How much are you currently owed through claims and how many claims have been denied within the last 30 days? Assess how you’re approaching each process and identify where you might improve to avoid issues.

Regularly collect and assess payment data.

While the first step will help your practice with initial assessment, that doesn’t mean your data collecting days are over. To the contrary, your practice should be assessing each of these elements, particularly the gap between money owed and money collected from both individual patients and insurance companies. By viewing claims that are regularly denied, you can identify why claims are being rejected and implement a plan to prevent future denials, thereby cutting down on your current workload.

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Prevent and be proactive regarding denials.

And right there, ladies and gentlemen, is the key element. For a healthcare practice to thrive, constant monitoring of insurance claims is absolutely essential. Understanding the ICD-10 coding system is essential on the front end, but understanding the contracts and policies of these companies—particularly as they relate to deadlines for submission of initial claims and resubmission of denied claims—can mean the difference between receiving payment or not.

Continuous monitoring of your practice’s revenue stream, particularly with regard to insurance claims, can make a huge impact on your practice’s bottom line. While the focus should always be on the patient and how best to provide excellent care, your practice cannot thrive without effective revenue cycle management. Using the steps above, you can help your patients receive the care they deserve.

Originally published Jun 9, 2015 / Updated Feb 8, 2018.