Healthcare revenue cycle management covers administrative as well as clinical responsibilities. Additional federal regulations, particular for Medicare and Medicaid, increase the challenges to improve your practice's revenue cycle management performance.
First, you must understand the items that contribute to your performance. Among the common components of the revenue cycle management umbrella are the following areas.
Revenue Cycle Management Common Components
- Patient and claims submission scheduling.
- Charges and fees for patient services.
- Timely billing.
- Accurate claims submissions.
- Collecting all payments due--when due.
The most effective way to successfully manage these necessary functions is by using state-of-the-art revenue cycle management (RCM) software. An integrated system captures patient information to start the process. The cycle continues as you provide patient care and bill for services. The process ends when your practice receives reimbursement from payers or patients.
Electronic Health Records
Since the transition to electronic health records (EHR) is proceeding, RCM should always utilize the most current technology to capture vital information that will maximize revenue. It's imperative that your staff enters accurate patient data at registration and throughout the diagnosis and treatment process.
Entering correct codes, timely billing, and understanding payer requirements and "quirks" displays the real power of EHRs, while improving your revenue collection. Since the HITECH Act offers Medicare and Medicaid incentives for using EHRs and current technology, using effective RCM software is a wise decision.
The upside of these Medicare/Medicaid incentives comes with a potential downside. Medical providers must display "meaningful use of EHR technology" by 2015, or face monetary penalties. This feature should give your practice more encouragement to install RCM software that includes a strong EHR component.
How to Improve Your RCM
Although not necessarily the only way to improve revenue cycle management, using top RCM software, particularly in light of the EHR requirement, is easily the best, most effective way to cost efficiently increase the amount and timing of your revenue. According to Healthcare Finance News, there are additional steps you can take to improve your RCM performance. These tips are offered by John Gallagher, of Simpler Consulting.
- Focus on your practice mission. You defined your practice mission for good reasons. Unless those reasons change (in which case you should modify your mission), remain focused on your mission as the captain of your medical ship.
- Always stay up-to-date with legislative changes. You're no doubt aware that legislative changes typically can affect your revenue cycle. For example, understand and prepare for the 2014 implementation of the Affordable Care Act (ACA) and the ICD-10 code conversion. Staying current with the potential revenue impact of legislative changes helps you improve RCM before suffering downside results.
- Work with payers to understand the nuances in their contracts and agreements. Management decisions and/or legislative initiatives lead payers to, at times, change their contracts and agreements. It is their responsibility to inform you of modifications, but your responsibility to understand the changes.
- Accurately comprehend your total "value stream." Do your services add value to your patients and practice? If they do, understand the real value you offer to better focus on RCM. Not just an income stream, your value stream can offer a realistic benchmark to help you improve RCM.
- Do not depend on RCM software alone to solve all practice revenue cycle issues. There is a common--but erroneous--tendency for physicians to put too much faith in top RCM software to solve all practice revenue shortfalls. You must fully comprehend the strengths and weaknesses of your practice, understanding the economic effects of demographics, environment and legislative changes. While this software can speed and integrate the entire RCM process, knowledge of your practice is invaluable to maximizing performance.
Many practices, lacking high level internal IT and financial staff, find that outsourcing the RCM function with a top firm, such as M-Scribe Technologies, is the best option. Top third-party firms employ the best IT talent and use the most cutting-edge RCM software available. The combination of outstanding technology and knowledge of your practice revenue sources help you improve revenue cycle management.
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