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Last updated on 2024年9月21日

How can healthcare providers improve their revenue cycle management?

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Revenue cycle management (RCM) is the process of tracking and optimizing the financial performance of healthcare providers. It involves managing the entire lifecycle of a patient encounter, from scheduling and registration to billing and collection. RCM can be challenging for healthcare providers, especially in the face of changing regulations, complex reimbursement models, and rising patient expectations. However, with the right strategies and tools, healthcare providers can improve their RCM and achieve better outcomes for their patients and their business. Here are some ways to do that.

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JANIECE FOWLER

Expert in all facets relating to Medical Billing and Coding.Training and educating on all things related to the…

1 Automate and streamline workflows

One of the key aspects of RCM is ensuring that the workflows are efficient and error-free. This means reducing manual tasks, eliminating redundancies, and integrating systems and data sources. Automation and streamlining can help healthcare providers save time, reduce costs, and improve accuracy and compliance. For example, using automated eligibility verification, prior authorization, and claim submission can reduce denials and rework. Using electronic health records (EHRs), practice management software, and billing software can facilitate data exchange and coordination among different departments and stakeholders.

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JANIECE FOWLER

Expert in all facets relating to Medical Billing and Coding.Training and educating on all things related to the complete Revenue Cycle Operation.
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Continuous ongoing training and education. No matter the titels and or education. Experience is crucial.regarding the full rcm. As this particular operation and has Multifacet's to complete processes. Most facilities don't understand how one position to the next ultimately effects your reimbursement rate.

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Jessica Scott

Revenue Cycle Manager United Digestive
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Another example of an area that needs to be streamlined is following up on claim status for claims with no response. In many cases, you have to go directly to the payer website login and search individual claims just to get a status. Practice management and billing software should leverage clearinghouse connections to auto status a claim after 20 or 30 days and drive those into workable queues.

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Carrie Krasinski-Voelker

Revenue Cycle Manager at H3 Management LLC
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We focus so much on the current revenue that practices forget about their aging. You can have clean submissions, verify eligibility, this doesn't mean that in the past it was done correctly! Have a yearly blitz, where staff works on aging and you will see revenue increase. This can also be used as a teaching tool as well. You will see a pattern in what's commonly getting denied and what could have been done to avoid it!

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Manohar Kamalapurkar

Product Director at Modus | HealthTech Innovator | Data Science Aficionado | Intrapreneur | Thought Leader in AI, Digital Health, and RCM | Product Strategy | Machine Learning Advocate | Healthcare Storyteller| EDI SME |
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AI can majorly simplify RCM by automating the most vital functions, hence reducing manual work and increasing productivity. It automates the populating of claim elements according to payer rules for cleaner claims, automatic eligibility verification prior to submissions, and tracking of claim status for prompting attachments of documents when necessary. In addition, AI will automate the preauthorization processes in cases of lapsed authorizations, ensuring that such a process remains compliant, and denials are restricted. These innovations will lead to efficiency and accuracy in the operation of healthcare RCM.

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Tye Reynolds-Black
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Healthcare providers can enhance their revenue cycle management (RCM) through various strategies and best practices. A streamlined and efficient RCM process can contribute to improved financial health for healthcare organizations. One way healthcare providers can enhance their revenue cycle management is by implementing a robust Denial Management system to identify and address common denial reasons. Also, analyze patterns of denials to prevent recurring issues.

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2 Enhance patient engagement and satisfaction

Another important aspect of RCM is enhancing patient engagement and satisfaction. This means providing patients with convenient and transparent access to their health information, payment options, and support services. Engaged and satisfied patients are more likely to adhere to their treatment plans, pay their bills on time, and recommend their providers to others. For example, using patient portals, online scheduling, and mobile apps can improve patient access and communication. Using price transparency tools, payment plans, and digital payment methods can improve patient financial experience and loyalty.

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Jessica Scott

Revenue Cycle Manager United Digestive
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In my experience automating, the payment plan process significantly increases propensity to pay and patient satisfaction. Patients can often be embarrassed about asking for or utilizing payment plans, and the ability to set up plans that meet their financial needs and automate the payment process can go along way towards resolving these issues.

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Carrie Krasinski-Voelker

Revenue Cycle Manager at H3 Management LLC
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This is huge! Patient satisfaction is one of the most important key aspects to a successful business! You can have the lowest prices but if your patients are not satisfied, you won't have patients! Transparency, transparency, transparency!! Submit predeterminations, have patients sign it and remind them when making the appt, verifying the appt and the day of the appt. Also, I see so many practices not taking pts copays at the time of the appt. Do not wait until the insurance pays, it's called a copay for a reason!

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3 Leverage data and analytics

A third aspect of RCM is leveraging data and analytics. This means using data to measure and improve performance, identify opportunities, and anticipate challenges. Data and analytics can help healthcare providers optimize their revenue cycle processes, enhance their decision making, and demonstrate their value. For example, using dashboards, reports, and benchmarks can help monitor key performance indicators (KPIs), such as days in accounts receivable (A/R), denial rate, and collection rate. Using predictive analytics, artificial intelligence (AI), and machine learning (ML) can help forecast demand, prevent fraud, and personalize care.

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4 Secure data and comply with regulations

A fourth aspect of RCM is securing data and complying with regulations. This means protecting data from unauthorized access, misuse, or breach, and adhering to the relevant laws and standards. Data security and compliance can help healthcare providers avoid fines, penalties, lawsuits, and reputational damage. For example, using encryption, authentication, and backup can help prevent data loss or theft. Using HIPAA compliance software, audits, and training can help ensure data privacy and security.

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5 Partner with a sales engineer

A fifth aspect of RCM is partnering with a sales engineer. A sales engineer is a professional who can help healthcare providers find and implement the best solutions for their RCM needs. A sales engineer can provide technical expertise, product knowledge, and customer service. A sales engineer can also help healthcare providers evaluate their current RCM situation, identify their goals and challenges, and recommend the most suitable products and services. For example, a sales engineer can help healthcare providers choose the right software, hardware, and cloud services for their RCM, and provide support and training throughout the implementation and operation stages.

RCM is a vital function for healthcare providers, but it can also be complex and demanding. By following these tips, healthcare providers can improve their RCM and achieve better results for their patients and their business.

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6 Here’s what else to consider

This is a space to share examples, stories, or insights that don’t fit into any of the previous sections. What else would you like to add?

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How can healthcare providers improve their revenue cycle management?

1

2

3

4

5

6

1 Automate and streamline workflows

2 Enhance patient engagement and satisfaction

3 Leverage data and analytics

4 Secure data and comply with regulations

5 Partner with a sales engineer

6 Here’s what else to consider

Sales Engineering

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How can healthcare providers improve their revenue cycle management?

1

2

3

4

5

6

1 Automate and streamline workflows

2 Enhance patient engagement and satisfaction

3 Leverage data and analytics

4 Secure data and comply with regulations

5 Partner with a sales engineer

6 Here’s what else to consider

Sales Engineering

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