The COVID-19 pandemic has put stress on hospitals and healthcare providers like never before, patient volumes are decreasing and the management has to resort to proactive solutions which can improve both patient care and your revenue cycle. Revenue cycle management (RCM) shows your financial success and efficiency by evaluating KPIs. Having robust RCM solution practices can avoid inaccurate reimbursements and the issue of bad debt – Meaning the red flags to financial failure can be prevented by correctly analyzing the revenue cycle management processes.
The most common barricade practices face ineffective RCM procedures is time. Fortunately, due to the pandemic, remote staff have time available to take on such an in-depth, collaborative task which can help your practice grow through Revenue Cycle Management success.
How to Document your Revenue Cycle Management Process?
Plan the details of your RCM Processes – The first step is mapping out your Revenue Cycle Management processes which includes both front end and back end operations. Examples of front-end operations include; appointment scheduling, eligibility verifications, and authorizations. Back-end operations comprise; coding, charge entry, submission of claims, and denial management. Once the details are mapped out you can then document your processes for every operation included.
Front end Operations
- Appointment Scheduling – Effective patient scheduling is the key to avoid the issue of missed appointments and therefore lost revenue collection. The front office members should know the information needed at scheduling and these need to be documented in the RCM process.
- Eligibility verification – The eligibility verification feature is common to most Billing Services EMR Software systems. The feature is an automated service that handles benefits verification hence freeing up staff time. The management should make it a point that the staff members know the difference between eligibility and benefits verification.
- Authorizations – If a practice doubts a patient’s coverage then it is advised that they always double-check. Members can make a list of payers that require authorizations and then process to obtain these authorizations need to be recorded.
Back end Operations
- Coding – Accurate coding leads to quick payments and a greater revenue stream. If the codes are not precise and don’t match with the procedure then the claim can be denied and it could lead to delayed payments.
- Charge entry – It is advised that the charge should be entered earliest as possible to enhance completion rates and KPIs.
- Claims submission – Claims submission means how your practice will be paid. It includes the person who is responsible for claims scrubbing and who reviews the final claim before it is submitted.
- Denial management / AR follow-up – Once claims are received by the payer’s then constant follow-up is needed for denied or unpaid claims.
Once all these steps are correctly documented you need to measure your results using the report generation feature and key performance indicators. Reports may be needed weekly or monthly to track down performance. KPIs include charge lag, payment lag, reimbursement rates, and First Pass Resolution Rate. Finally, it is critical to share these results with your team members so they can feel encouraged to enhance their performance and can also improve self-confidence for positive changes in the workflow environment.
