How to Improve Your Revenue Cycle Management in 90 Days

Comprehensive 90-Day Plan to Improve Revenue Cycle Management (RCM)

Phase 1: Weeks 1-4 – Assess and Identify Gaps

Objective: Establish a baseline and pinpoint inefficiencies.

1. Audit KPIs Expand Metrics Tracked: Include denial rates, days in A/R, collection rate (% of net collectible revenue), clean claim rate, patient liability collection rate, and aging buckets (e.g., claims >90 days).Tools: Use EHR reports or RCM software (e.g., Epic, Cerner) to extract data. Consider benchmarks from MGMA or HFMA for comparison.
2. Identify Bottlenecks Process Mapping: Conduct workflow analysis for registration, coding, claims submission, and collections. Use swim lane diagrams to visualize handoffs. Root Cause Analysis: Hold cross-departmental workshops to identify issues (e.g., front desk errors due to rushed check-ins, coding inaccuracies from outdated guidelines).
3. Standardize Documentation Checklists: Implement registration checklists (e.g., insurance verification, copay collection) and coding audits. Training: Role-specific training for front desk staff on data entry and EHR use (e.g., ensuring correct patient demographics).
4. Stakeholder Alignment Form an RCM task force with representatives from billing, coding, and clinical teams. Set weekly review meetings.

Phase 2: Weeks 5-8 – Optimize Billing and Claims

Objective: Reduce denials and accelerate claims processing.

1. Enhance Coding Accuracy Certified Coders: Hire or train coders on ICD-10/CPT updates. Use AI tools like Optum360 or AAPC’s Code Health for audits. Audit Schedule: Conduct weekly coding reviews for high-volume specialties.
2. Proactive Denial Management Denial Dashboard: Categorize denials by root cause (e.g., prior authorization, coding, eligibility). Assign teams to address top 3 issues (e.g., payer-specific rules for modifiers).Appeal Process: Create templates for common denial reasons (e.g., missing documentation).
3. Streamline Claims Submission Automation Tools: Implement claims scrubbers (e.g., Change Healthcare, Waystar) to flag errors pre-submission. Payer Partnerships: Schedule meetings with top payers to align on submission requirements (e.g., electronic vs. paper).

Phase 3: Weeks 9-12 – Strengthen Collections & Analytics

Objective: Improve cash flow and sustain results.

1. Collections Team Optimization Dedicated Follow-Up Team: Assign staff to track aging claims using prioritization (e.g., high-balance accounts first). Use predictive dialers for payer calls. Patient Payment Solutions: Offer online portals, payment plans, and estimate tools (e.g., ClearBalance). Train staff on empathetic financial conversations.
2. Data-Driven Adjustments Analytics Dashboards: Monitor real-time metrics (e.g., denial trends, A/R aging) via platforms like Tableau or Power BI. Feedback Loops: Share performance data with staff monthly; adjust strategies based on trends (e.g., retrain coders if E/M denials spike).
3. Patient Engagement Education: Distribute brochures/videos explaining insurance basics and payment options. Use text/email reminders for overdue balances.

Post-90 Days: Sustainment & Growth

• Continuous Improvement: Quarterly audits, annual staff certifications, and bi-annual payer reviews.
• Technology Upgrades: Evaluate AI/ML tools for predictive denial modeling or robotic process automation (RPA).

Overcoming Challenges

• Change Management: Secure leadership buy-in via ROI projections (e.g., “Reducing A/R by 5 days = $X revenue”). Celebrate early wins (e.g., 10% denial reduction).
• Compliance: Partner with legal/IT to ensure new tools meet HIPAA and PCI standards.

Free Checklist Highlights

• Weekly Milestones: E.g., “Week 2: Complete registration process map.”
• Accountability: Assign owners for each task (e.g., Billing Manager for denial dashboard setup).

By integrating these steps, practices can achieve a 15-30% reduction in denials and accelerate cash flow within 90 days. For personalized support, consider consulting RCM experts like MBC to tailor strategies to your practice’s needs.

Download the full checklist and transform your RCM today!