Maximize Your Healthcare Revenue Cycle Management

 

With sweeping changes rolling over the way healthcare providers receive payment in the past several years, many companies are due for a complete re-evaluation of the way they handle Revenue Cycle Management (RCM). Between the Affordable Care Act changes in 2012 and the ICD-10 implementation transition currently taking place, countless providers are seeing incredible paradigm shifts in the performance expectations of their RCM.

 

To ensure that these providers are getting the maximum effectiveness and profitability out of their RCM services, here are some “checkup” methods they can use to identify and diagnose common revenue cycle problems:

 

Set Benchmarks and Measure Them

The British mathematician and engineer Lord Kelvin once famously said: “If you cannot measure it, you cannot improve it.” Countless industries from marketing to manufacturing use this line of thinking to push forward programs that ensure efficiency, productivity and even viability for the systems they have in place.

 

Your provider organization should, too. Create a set of benchmarks for your RCM performance and see if you can slowly improve them over time. You can also use comparative data from other organizations to keep you on the straight and narrow.

 

Possible metrics to track include days a claim spends before being sent out to billing and your general Medicare reimbursement rate.

 

Get the Money You Are Owed

When evaluating metric performance as suggested above, make sure that you are paying attention to one of your most important metrics: collection rate. Practices and organizations that have a significant amount of accounts in collections are vulnerable to being cash-starved.

 

Good RCM services providers will be able to retrieve around 96 percent or higher of their accounts in collection. Take steps to bring your rate up to this number or at least above 85 percent, or your percentage of patients with outstanding bad debt could get out of hand.

 

Audit Workflow

Charting your typical billing cycle workflow from patient scheduling to final claim submission can help you re-evaluate your current system. You may discover obstructions or inefficiencies that hinder your ability to process claims in an expedient manner.

 

Solicit advice from other provider organizations and even your front office employees on how to streamline these processes. You just may be taking for granted something that is holding your RCM’s profitability back.

 

Track Denied Claims

With ICD-10 in place, providers are expecting a much higher rate of denied claims because of improper coding practice. Any of these claims that happen to come back should be noted in some type of compiled file or database to track trends in mistakes or billing practices. The discoveries made during this process could provide invaluable information for ongoing ICD-10 training initiatives.

 

Look Ahead to Policy Changes

The ACA may be firmly in place, but many insurers are still adjusting to how it has affected their payer ecosystem. Similarly, the ICD-10 rollout has many insurers balking at whether they will follow lockstep with the CMS or if they will accept practices like dual coding.

 

Chart your most commonly-used reimbursement payers, and make inquiries into any major policy changes occurring in the upcoming years. You may find that your current system is not set up for maximum probability of reimbursement given the payer’s policies — or if it is, that it may soon not be once policy changes come into effect.

Pay Attention to Self-Pay Balances

Like accounts in collection, self-pay balances can be a major risk to an organization. A rise in the popularity of low-premium but high-deductible plans is likely to correspond with a rise in these self-pay balances.

 

Stay on top of each one, and find out how to work with individuals so that their accounts do not have to go into collection. This task is time consuming, but it keeps needed revenue streams from drying up when self-pay patients feel overwhelmed by mounting debt.

 

Make Sure Your Current RCM Services Systems Meets You Needs

A standard practice in any business is to periodically question the value your current vendor is providing. While your organization has likely made a recent switch to comply with ICD-10, never assume that the best RCM services and support provider now will be the best several months in the future.

 

Make research ongoing into pricing, service offerings and the latest software systems so that when your RCM’s contract comes up for review, you do not renew it without any forethought. Ongoing developments and improvements in ICD-10 implementation will only stratify the value RCM services providers will be able to offer as time goes on.

 

This article was written by our guest blogger, Alex Tate from CureMD. Alex Tate is a digital marketing specialist, content strategist, and a health IT Consultant who provides perceptive, engaging and informative content on industry wide topics including EHR, EMR, practice management and compliance.

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