We’ve put together the five essential steps practice managers can take today to improve the RCM processes.  

As a practice manager, you understand how crucial it is to the profitability of any medical practice to have an established and efficient revenue cycle management (RCM) process in place. A typical RCM process includes multiple tasks such as validating patient information, accurately capturing diagnostic codes, tracking claims, collecting payments, following up on rejected claims and more. Each step in the RCM process is as important as the other to ensure that the care delivered to patients is paid for timeously.

But the reality is that managing revenue is becoming increasingly more difficult. Patients are feeling the effects of the economic climate. Many have to dig deeper into their pockets to pay for healthcare services and an increasing number are finding it difficult to pay, or to pay on time.

In addition, the shift from a fee-for-service to value-based reimbursement model is gaining traction and will impact how practices bill for services. Together, these factors mean that practices will need to be proactive in managing patients both from a clinical and financial perspective. Practice managers are at the centre of preparing for and managing these changes whilst ensuring that the practice is financially sound. 

Map out your RCM process

The purpose of mapping out your RCM process is to identify ways collections can be improved and if there are any bottlenecks that need to be addressed. For example, staff should collect patient information when the appointment is made and this information should be verified and pre-authorization received from the medical aid where applicable.

Mapping out the end-to-end process gives you a lot of valuable insights that will guide changes and is a crucial first step to making improvements.

Review your processes with patients in mind

Most practice managers will have a payment policy in place. It’s a good idea to review and update the policy regularly but it’s equally important to ensure that staff are familiar with what the practical payment collection procedure is, before and after the appointment. They should be able to answer questions and effectively communicate relevant information to patients before they arrive for their appointment. Not to mention working with patients to find solutions if they are unable to pay.  Patients are the lifeblood of any medical practice and how collections are managed is crucial to the practice’s reputation and financial growth. Click here for a guide on some of the most frequently asked co-payment questions that patients ask their medical providers and how your practice can deal with them.

Enlist the help of technology

The RCM process is complex and often fraught with coding and manual data capture errors, miscommunication and can take up an unnecessarily large amount of time. A digital billing and practice management system gives you the ability to customise templates to reduce coding errors for example, or offer a streamlined way to ensure that procedures and consumables are billed accurately. It’s a good idea to go back to the document whereby you mapped out your practice’s current RCM to see where you can reduce bottlenecks and apply automation for maximum efficiency.  

Use a dashboard with key metrics

Tracking data is an important part of improving your RCM process. A digital billing and practice management system offers practice managers key insights at a glance that you can use to effect changes. Decide beforehand which metrics you want to track for example collections, procedures and consumables, rejected claims, bad debt etc. to know what areas to focus on to see improvements across the RCM process.

Make use of easy-to-read reports that offer you insights into your practice’s clinical and financial performance. Understanding where you are now, and deciding on measurable improvements and how to realise those improvements are all decisions that can be guided by the data the practice collects on a day-to-day basis.

For more about the key financial metrics your practice should be using, click here.

Engage your staff

Along with patients, your staff is at the centre of your RCM improvements. They need to understand the importance of all of the steps in the process, and their role in ensuring that payments are collected timeously. As mentioned previously, each person who engages with patients about payment should be well versed in how to deal with a variety of scenarios for the best possible outcome.  It’s also very important that staff know how to use the technology that makes each step easier, less time consuming and prone to error. Ensure that they have been suitably trained and are comfortable using a system to manage patients using the most up-to-date and accurate information.

Ultimately, your RCM process should be designed to optimise revenue, not just manage it. Following the tried and tested steps outlined in this article doesn’t have to be an exhaustive process. Get in touch today to find out how Healthbridge can help you make the most of your RCM process.