Five steps to take to master a revenue cycle management process

Being a healthcare professional is a challenging mission. Every day, most of you have to balance between saving lives and dealing with the issues related to payments.

With that in mind, you are obviously familiar with the aspects like claim denials, recoupments, and payer credentialing. All these aspects constitute a process known as “revenue cycle management”, or RCM. Healthcare revenue cycle management is the financial process healthcare providers face to manage appointment scheduling, claims submission, processing and payment collection. It starts from the moment when a patient schedules an appointment and ends after the claim for the rendered service has been reimbursed in full.

Having a properly set RCM is key to achieving a financial prosperity of your practice. Here is a list of things that you can do to minimize financial gaps and losses:

11)    Go digital – in 2022, it’s old-fashioned to use paper claim forms and chart records

It is no secret that electronic insurance claims and medical records are processed faster than their paper-based counterparts. According to our internal research, delays caused by delivery and mailing of paper-based documentation are the leading cause of gaps in revenue flow. Imagine how long it may take to deliver a batch of claims from New York to California!

In order to digitalize your RCM, first you would need to set up an electronic billing system and sign a contract with a clearinghouse that would submit your claims to insurance payers. There are hundreds of both of them on the market. Your next step would be to set up an electronic healthcare records system (EHR) – a software that would help you create and store medical records and superbills securely.

Finding a good billing software and EHR can indeed be a rocket science! Luckily, We Can Help you with that.

Try our all-encompassing medical billing solution and EHR to keep delays in reimbursement at bay.

22)    Set up a clear-cut collection process

This year it is as critical as never to ensure that you & your staff collect things appropriately. By “collection” we mean not exclusively getting copays and deductible payments from your patients. Instead, now you would need to make sure thar every piece of required information is collected and utilized quickly & efficiently. This includes, but is not limited to:

• Patient’s demographic information – to avoid rejections/denials
• Patient’s plan coverage-related information – to know how much money you would need to collect from your patients after an insurance pays its share
• Contemporary clinical and reimbursement guidelines – to ensure that your service will be paid as expected

33)    Minimize coding and billing errors prior to submitting a claim

In order to enjoy a consistent cashflow, it is extremely important to ensure that your services are on the same page with the current billing and coding guidelines. Our experience shows that improper procedure coding results in 25% of all claim denials. We recommend you utilize specific billing/verification software when preparing your superbills or claims. WCH iSmart has a built-in electronic superbill feature with dozens of templates and hundreds of procedure codes tailored for your practice. In addition, you may simply “hit the books” or use some online portals when coding a claim, to verify if a procedure or a diagnosis code you are about to report are done so appropriately. Upcoding and downcoding lead healthcare providers to nothing but underpayments.

44)    Deal with rejections and denials straight away

If you bill many claims to commercial payers, you are already familiar with unnecessary and illogical denials for your services. Unfortunately, insurance payers often do not reimburse for services that are covered by the plan and are billed appropriately. While some practitioners and reimbursement specialists prefer to deal with denied claims in bundles by the end of the year, we assure you that this is not a good strategy. WCH Service Bureau recommends you reprocess/appeal your underpaid claims immediately after you receive a denial notice. This is largely because many insurance payers have strict deadlines and time frames to receive a request for claim reconsideration. In most cases, it is 180 days since the denial date. So, if, let us say, you received a claim denial in January, but sent an appeal only by August of the same year, you would most likely not get any payment for your service.

55)    Outsource your RCM to a team of specialists

It is easier & more effective to outsource your medical billing and claim collection to a third-party entity like WCH Service Bureau. Our team of RCM experts will ensure a 98-100% claim reimbursement rate to your practice with minimum interruptions. Contact us to get the details of our all-encompassing offer.