Last updated May 14, 2018
Whether you run an ambulatory surgical center or a private practice, one thing is certain – you want to wring every last dollar you can out of your revenue cycle. And why wouldn’t you? Higher patient balances, lessening cash flow, tighter margins, and higher competition means every last dollar is needed to keep your revenue healthy.
Here are steps you can take to help with revenue cycle management.
1. Have a registration checklist
Insurance changes happen for a variety of reasons; job changes, government policies, etc. Verifying insurance is a vital upfront step and can be done properly by completing the following checklist:
- Copy insurance card(s)
- Review the insurance
- Verify the patient’s identity
- Verify the patient’s demographics
2. Use a pre-admission check-in by phone or email
When this type of contact occurs, the recipient of the information can update patient information and verify insurance. If there is a co-pay, he or she can let the patient know and remind them of the payment methods your medical facility or physician practice accepts. Do you accommodate the digital demands of consumers? If not, you should definitely develop a plan towards providing more digital touch points for your patient’s.
3. Function as if you are a retailer
No one walks away with merchandise after paying only 80 percent of the price. This same concept should apply to medical services, but unfortunately it does not. Layaway options are provided in the retail world. Likewise, surgery centers and hospitals should educate their patients on payment policies and payment options.
4. Make sure that claims are checked and rechecked
A denied claim puts you at an immediate and ongoing disadvantage of ever collecting from health insurance. Make sure your staff has a process for properly reviewing claims and not relying 100% on technology to get it right. If you have contracts with major payers, review the contracted rates in your billing software and make sure they are always up-to-date. Always review payment history before renewing a contract so you can address recurring issues during the contract negotiation.
5. Have claims paid electronically
Most insurance companies prefer or mandate electronic payment. A benefit of today’s claims management software is it also connects to electronic remittance and offers you an immediate audit trail.
6. Manage denial claims promptly
Different payer contracts have different time limits. A denial that results from a failure to file an appeal or corrected claim is difficult and time-consuming to overturn.
Good practice management knows that revenue cycle management is where the business of medicine and clinical practice come together. The basics of revenue cycle management are always the same even if they look slightly different between a private practice, ASC or hospital.
Perseverance and the correct RCM tools can help you manage your revenue cycle with limited denials and prompt co-pays. Talk with an RCM professional at abeo if your medical facility or physician practice could benefit from outsourced revenue cycle management, medical coding or transcription services.