Revenue Cycle Management Optimization Tips for 2020

Here are just a few ways in which a healthcare provider can optimize their RCM in 2020 without needing to resort to any major financial investments.

18th Mar 2020
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Medical practices and healthcare providers alike suffer from revenue leakage arising from claims denials, medical billing errors, incomplete claims documentation, and lack of insurance coverage, to name a few. Without a sound RCM process in place, these entities can easily go out of business. So, what can possibly be done to plug revenue loss in the short term to keep a business profitable you ask?

1.  Reconfirm Your Patient’s Insurance Eligibility Status


It should be a requirement for your patients to present their insurance policy number or insurance card every time they submit any forms or schedule any appointments with you. Although it may seem like it might be a waste of time for them, if you are looking to optimize your RCM, all possible sources of confusion need to be avoided at all costs.


By resubmitting their insurance information, your patients are essentially reconfirming their insurance eligibility status when it matters the most. By updating the system at several points during the admitting process, your practice can ensure that nothing slips through the cracks so that non-payment is never a challenge you have to face with your patients.


Also, in this way, insurance providers can also update their systems with the most recent insurance information on file for the policyholder and you can confirm their insurance eligibility with greater accuracy to avoid RCM complications and unexpected debt from arising along the way.


Because ineligibility is the reason behind most claims’ denials, medical practices can optimize their RCM by only providing services for those patients with proper insurance coverage. Being told that no payer exists after medical treatment and services have been provided is no longer an option by reconfirming their insurance eligibility at regular intervals.

2.  Implement More Rigorous Scheduling Practices


Revenue cycle management can take a hit when patients fail to show up for their scheduled appointment. The services and billable hours that could have been recorded have disappeared into thin air and have started to contribute to the declining health of your revenue cycle. To fix this crisis, it is important that you counter no-shows in the near future by automating patient reminders.


When you send your patients reminders of their appointment after it has been set, you better support and optimize your RCM. This is because most scheduling software can accommodate reminders in various forms to patients in their medium of choice – whether that be through texts, pre-recorded phone calls, email, or any other channel.


Alternatively, you can also invest in a web-based system or online portal through which appointments can be booked to help optimize your RCM. By enabling your patients to schedule their own appointments, you ultimately put the ball in their court, so that all the necessary information is available to them when it is needed so that fewer scheduling clashes occur. In this way, you are also improving their overall experience, as they no longer need to schedule the appointment twice because they failed to make it to the first one.


Online appointment scheduling is an effective way to optimize your RCM as a fuller schedule means more predictable revenue streams and less revenue loss. More consistent revenue streams add up to a healthier revenue cycle, and greater profits all round.

3.  Develop More User-Friendly Billing Statements

Billing disputes often arise from a lack of clarity around what is contained in the billing statements. Patients get frustrated trying to decipher poorly worded or ambiguous terms or conditions in the medical bills they have to pay, which can lead to overwhelming billing disputes and longer payment cycles for you.


If your medical practice, however, redesigns your billing statements to read better and reduce confusion around certain terms or charges, you stand to gain from both happier patients and faster payment cycles for your revenue cycle management.


A patient-friendly summary of charges and balances due will inform patients of their total balance and how it can be broken down so that different categories arise, like “medical supplies” and “diagnostic tests”. This can leave patients feeling like the medical services they received were thorough and that only the most essential tests and supplies were charged to their account – which can speed up payment on their end.


Carefully designed billing statements can alleviate your non-repayment concerns as more patients feel certain that only the most necessary expenses were charged. This can help you optimize your RCM as a steadier stream of revenue comes in due to more user-friendly documentation and best practices being used on your end.

4.  Ensure That You Scrub Claims Thoroughly to Reduce Denials


Instant claim denials can result from missing information in submitted documentation, ICD-10 coding discrepancies and errors, and other unwarranted filing errors in general. By using an RCM system that scrubs all claims for inaccurate or missing information, your practice can essentially lower your chances of your claim being denied.


Implementing a claim scrubbing process can be a great way to help you reduce your losses because each claim is vetted for completeness and accuracy of information prior to being sent to the insurance provider. Only claims that can be reimbursed then go through your system, which effectively lowers your claims denials rate substantially. This can result in a boost in your revenue stream, which means that you have further optimized your revenue cycle management in the process.


Although the ways in which medical practices lose out on revenue or promote revenue leakage are many, there are just as many ways to nip it in the bud. Whether you choose to use more user-friendly billing statements, implement thorough claims scrubbing, use more rigorous patient scheduling practices, or reconfirm patient insurance eligibility status throughout the process, by implementing more strategic business practices you can minimize your revenue loss and optimize your revenue cycle management in 2020 without a hitch.

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