Introduction
An efficient revenue management system helps track your organization’s healthcare. Without one, you can lose thousands of dollars in patient payments and reimbursements, affecting operational costs.
This blog will walk you through the steps of revenue cycle management. These steps will make your revenue flow smoother and keep you in control of your money.
Create Your Revenue Cycle Management Workflow
First, learn about the whole medical billing process, from when a patient schedules an appointment to when their bill gets fully paid.
Once you know this, you can get outsourced billing services to handle RCM or use RCM software that fits your needs.
Making sure Your Revenue Cycle Management Team is On Board
Once you’ve chosen the right model for your organization, the next step is aligning your staff. This is crucial for the success of your financial management system.
Your staff members will use the revenue cycle management daily. They need to understand how to use it efficiently, considering the goals of reducing paperwork and increasing payment returns.
When introducing a new RCM model, you must provide your staff with proper onboarding and training. This will help them work effectively and make the transition smoother.
Registering Patients
In the beginning, it’s important to get the correct information from patients. This helps with managing money properly.
If the information is wrong, it can cause problems later on. It might make things slower, and the data might be wrong, which is important for tracking how well the revenue is managed.
One good idea is to ask patients to register before their visit. This way, we can double-check their information carefully and avoid problems with insurance claims.
Checking Patient Eligibility
Proper registration of patients before they arrive is essential. This helps ensure they’re eligible for services.
A good revenue management plan should avoid asking patients to pay upfront. Otherwise, you might lose customers.
Your revenue cycle model must have correct insurance information. Here are three steps your team should take for patient eligibility:
- Check for any differences in patient details right away.
- Reach out to patients if there are any issues.
- Always verify if patients’ insurance is current and note any expired coverage.
Getting Approval in Advance
Patients might need to get approval by showing proof before some procedures. Your revenue cycle management should improve patient outcomes.
Automating the approval process beforehand can make things easier for your patients and, therefore, make them more likely to continue using your services.
Understanding Co-payments and Deductibles
Sometimes, you have to pay for medical services out of your pocket. If you forget to include these costs, your medical billing system can be messed up.
So, know which medical services your insurance won’t cover. Tell the patient about these services early.
It’s like adding icing on a cake. Also, let them know about any deductibles they can use. This shows you care about their money.
Claim Submission
Submitting claim forms on time is very important. It’s just as crucial as filling them out correctly. Make sure your employees understand this for the RCM system to succeed. Train them to check claim forms carefully before sending them. This helps avoid rejection due to code errors, claim format, or patient details.
Claim Reimbursement
Once you submit a claim, the insurance company will reimburse it. They check all the information and approve eligible claims. Often, they explain how much they’re reimbursing. You can use this feedback to improve your RCM’s claim submission process.
Claim Denial Management
If your claim is partially reimbursed or rejected, you need a process to fix it. Establish a good denial management workflow. This ensures your resubmission is better and increases your chances of getting reimbursed on time. It’s important to train your staff to be punctual during this stage.
If you notice any differences in your reimbursement, investigate them. Figure out why they happened and find solutions to improve the system. Payment differences can occur due to coding mistakes or late submissions. Keeping track of these details helps your revenue cycle management system succeed.
Checking Payment Differences
If your payments are different, it’s crucial to investigate and find ways to fix them.
Payment differences can happen for various reasons, like mistakes in coding or late submissions.
So, if you want to keep your practice healthy, Keeping track of these details helps your revenue system stay healthy.
Collecting Payments from Patients
This step is crucial in any medical billing system. Following up on payments requires patience and hard work.
A good revenue system helps explain insurance coverage to patients and encourages them to pay.
Reviewing Finances
A good revenue system allows you to check and adjust your financial goals. This helps improve services and build trust with patients.
Make sure your system gives you reports to help automate revenue management.
Especially after the tough times of COVID-19, it’s vital for health facilities to stick to each step of their Revenue Cycle Management System closely to thrive financially.
