RCM Strategies for Medical Practices

When it comes to running a medical practice, there are a lot of things you need to keep an eye on. The first and foremost concern is the health of your patients; however, the financial health of practice is just as important. A practice needs to maintain high profitability to keep itself running and this is where RCM or Revenue Cycle Management comes in.

Essentially, revenue cycle management is how a healthcare facility ensures the payment process is carried out properly and efficiently. This process can be broken down into three steps:

  1. Processing Claims
  2. The Actual Payment
  3. Generation of Revenue

Within this process, patient service revenue has to be identified, managed, and collected.

Identifying the best strategies for revenue cycle management is very important for any medical practice out there. While it can be fairly complex to see it through to the end, it’s advisable to develop a business sense when approaching these things as it’s vital to the success of your practice. Now, let’s go over the most helpful strategies you can employ to boost your revenue cycle.

  • Documentation
    There will definitely be instances wherein the insurance company may list an incorrect allowable amount. To prevent any delays and inconvenience, contact the relevant party on the insurer’s end and request that they provide the information which states the expected payment for all the CPT codes you will be using, in writing. Taking this a step further, the practice management system should have the allowable amount for every payer embedded. And, in the event of contract renewals or changes, it’s important to update the amount.

  • Efficient Financial Clearance Protocols
    Help employees save time by making it possible to check insurance coverage, benefits eligibility, and financial responsibility through quick and easy automated processes. This saves both time and effort. Additionally, make sure employees address any problems that arise.

  • Bedside Manner
    The staff needs to be appropriately trained so that they can directly engage with patients to request payment. A polite demeanor and the right words are vital here. Additionally, it’s advised that in the event a patient has any owing balances to tell them after they have already submitted a co-payment. This is to discourage partial payments

  • Submit Claims Correctly
    The most common reason for the denial of claims is the lack of appropriate information. From the very beginning of the process, it is recommended to ‘get it right’. Using automated coding tools and educating the staff on the business end is an effective way to prevent claims from being denied.

  • Attend to Denials Immediately
    However, even in cases where claims are denied, it’s crucial to resubmit them at the earliest time so that it’s still possible to earn some revenue. It’s of utmost importance to make sure that denials don’t pile up. A helpful method for dealing with denials is to assign one staff member to oversee everything as opposed to letting them compromise workflow.

  • Consistent Copay Collection
    When multiple clinics are involved, copay collection can become fairly inconsistent. To combat this problem you can create reference sheets, standardized documentation for the workflow, and make note of relevant transaction codes to ensure correct system posting.