Revenue Cycle Management
Physician-based organizations have a lot going on at once — from treating patients to managing financials, there always needs to be repeatable standards in place. With DoctorsManagement, your organization can verify and better understand the reliability of the revenue cycle management (RCM) process to implement needed stop gaps. This process helps you protect the integrity and overall health of revenue coming into the organization as opposed to moving out through recoupments, interest, fines, and penalties.
What Is Revenue Cycle Management?
Revenue cycle management is the medical billing procedure that navigates the reimbursement process for the services rendered to the patient, from an individual’s initial service to the receipt of payment for each service. However, there is more involved in this process than submitting claims and awaiting payment. The cost of RCM to an organization can fluctuate based on proper staffing and systems to create efficiency within the revenue cycle management process. In addition, billing that is misappropriated and neglects diligent resolution can also lead to increased costs.
The revenue cycle process in healthcare looks like this:
- Registration: The first step in the patient financial process is demographic intake and proper entry of demographic data that includes elements such as the patient’s name, address, and insurance information. Incorrect entries impact claim accuracy, which may lead to denials by the carrier. Ultimately, the rendering provider of service bears the weight of the compliance and accuracy of each claim, which requires reliable staff to ensure information is up-to-date at every encounter.
- Medical coding: After each patient encounter, a code is required to properly convey the performed services to the payor for reimbursement of treating their beneficiary. Coding often occurs in different ways across organizations, with some having medical coders who consider the documentation and append the code and others who rely on the provider to code each encounter. While either process can be appropriate, the importance of correct and thorough coding is vital to claim payment and the associated reimbursement for the service.
- Medical billing: The services are then ready for claims creation and submission to the payor for reimbursement. However, the medical billing team may add additional reviews to the submitted information to consider billing-specific concerns noted through claim scrubbing. The claim is then finally submitted — however, this does not ensure reimbursement of the service. A payor-specific policy may lead to the rejection or denial of a claim that will belabor reimbursement. The work of the billing team has just begun, as post-submission work might include claim rejection and reprocessing, denial of the service, and a patient collection process related to coinsurance, claims responsibility, and deductibles. The RCM process is not complete until the claim has been paid in full or adjusted as non-collectible in some instances.
Importance of a Revenue Cycle Analysis
An RCM expert on your side can assess the process, performance, efficiency, and thoroughness of your RCM to maintain sustainable revenue for your organization. Some specific and important aspects of a revenue cycle analysis include:
- Verifying sustainability of the current RCM model: Just as with any process, accuracy, standards and processes, and repeatability of procedures increase the long-term sustainability of successful RCM. RCM is a revenue throttle for your organization. If the throttle is blocked or bottlenecked or lacks integrity, incoming revenue may be paralyzed, which would then lead to a financial threat to the physician.
- Making educated decisions: Payor policy dictates claims reimbursement. Therefore, having a better understanding of your payors and their performance in claims processing significantly impacts the financial viability of your organization. A revenue cycle analysis provides a spotlight on problematic payor relationships that can offer a balanced understanding of payor relationship management and contract negotiations.
- Improving collections: For many in the RCM industry, billing has been a learned trade through on-the-job training, which is oftentimes successful. However, the training provided is often the byproduct of billing specialists who may be working on autopilot as opposed to working toward creative claims resolution processes. To have an opportunity for increased collections, whether from the carrier or the patient, each team member must know the best approach to resolving each claim, no matter the payor, the service, or the provider type. An RCM analysis can provide resources and training opportunities that ultimately lead to better claims processing with the expected outcome of improved collections.
- Reducing errors: Denials are costly to an organization, as they require the reworking of claims that could have led to reimbursement on the first submission. However, clean claim costs can also be a burdensome expense to an organization. Finding the right balance of work for each can be best identified through the findings and recommendations of an RCM analysis.
Medical Revenue Services
At DoctorsManagement, we have experts who can provide such an analysis and offer a plan for improvement. Your RCM process will be evaluated from claim inception through the collection procedure. These findings will lead to a recommended plan for immediate implementation to improve the performance of RCM, leading to revenue improvements and reducing the negative consequences of poor revenue cycle management.
Our expert creates a plan and assists in its implementation to ensure improved performance. This often requires team development and training and might also require ongoing RCM oversight.
Common RCM Analysis Findings that lead to an improvement plan and educational training include:
- Pristine AR coupled with lower-than-average reimbursement percentages
- High outstanding AR that lacks a plan or process for reduction
- Recurrent and high-volume claim denials, which bottleneck revenue
- Perceived payor prejudice, necessitating evaluation for out-of-network migration
- Lack of standards or processes for repeatability
- Prior authorization and certification impacts on RCM
Contact Us for RCM Analysis Billing Services
The business of medicine should be the focus of your organization, and patient care the focus of your providers. Let DoctorsManagement assist in providing insight into the volatility of your RCM processes to ensure a streamlined and high-yield process. Together, we can help you achieve better patient satisfaction, reduce compliance risks, and create a stress-free environment for your physicians and staff.
You can get closer to your RCM goals in medical billing by scheduling your free consultation with us today. We look forward to hearing from you and helping however we can.