Have you ever heard of the term ‘revenue cycle management’? Also called RCM, it is all about how you manage your practice’s claims processing, payment and revenue generation.

It includes validating patient information, collecting patient-liable amounts, coding claims correctly, tracking claims, collecting payments and following up on rejected claims.Let’s take a look back at some of the Industry Insights Newsletters of 2016 and see what the most significant RCM trends have been in South Africa, and what they mean for your practice.

Pre-appointment: Get the balance right when setting your consultation fees 

Setting the right consultation fee can be challenging. If it’s too high, you risk chasing away patients; if it’s too low, you might not cover your costs. The basic guidelines provided by medical scheme tariffs are all very well, but they are just guidelines – and every practice is unique. Based on an analyses of around 8 million General Practitioner (GP) claims sent during 2015, we identified 3 key factors that you should take into consideration when setting your consultation fee:

• Charge according to where you are located
• Know which medical schemes your patients belong to
• Include consumables in your fee.

For the full story, click here.

Appointment: Inform patients of money owing before they leave the practice. 

Studies have shown that patients who are informed of outstanding amounts while they are still at the practice are not only more likely to pay, but are more likely to pay sooner. In fact, one study showed how the chance of collecting from a patient drops by around 16%* as soon as they leave the practice.

Below is a table of the patient-liable percentage per average claim during 2015, by specialty:

On average, over a third of every claim sent (across all specialties) will have a patient-liable portion. It is therefore essential that you have the correct processes in place to collect any money owing by the patient before they leave the practice. This means checking patient benefits before the consultation, so they can be informed of any shortfalls upfront.

For the full story, click here.

Claim submission: Optimise claims to include all procedures and consumables 

As a doctor, how you bill for procedures and consumables can have a huge impact on your bottom line. You might feel it necessary to exclude procedures or consumable costs to help cash-strapped patients. But claiming in full for the services you perform is essential for the health of your practice, and should essentially come out of your patients’ day-to-day medical savings. Furthermore, it need not be an admin burden either, especially if you have the right practice management software, and ensure that claims are set up to capture procedures as well as consumables.

A pilot study on profitability performed in 2015 with a sample of 10 General Practitioner (GP) practices on our books found that consumables were often under-claimed or not claimed at all, and that procedure lines were often missing.

For the full story, click here.

Claim-response management: Analyse rejected claims to improve cashflow 

No matter how well you run your practice, you will at some point or other experience rejected claims. Did you know that even if rejected claims are running at as little as 4% of total claim volume, that will still equate to R48 000 a year for the average practice*?

This emerged from a study we did of more than 6 million claims sent between January and December 2015.  Although this cash may still be recovered by resubmitting the claim, it’s worth understanding why medical aids reject claims so that you can improve your cashflow and reduce your risk of bad debt. From the data we’ve analysed, here are the main reasons why claims are rejected:

• The patient claim information is incorrect, or has changed
• Stale claim – you’ve waited too long to send the claim
• Incorrect or missing codes
• Duplicate claim

For the full story, click here.

*Average number of claims sent per month, per practice was 367.

Collections: Invoice patients on the day of consultation 

The longer you wait to invoice a patient, the longer it will take for the patient to pay – which increases your risk of bad debt. This is supported by a study carried out by David Evans (21 June 2013; Free Agent), who found that invoices sent within a week of the work being finished were paid on average within five days. However, when the invoice was sent just one week later, payment time doubled to about ten days.

Closer to home, we also conducted a pilot study of our own. This study showed that the sooner a practice invoiced the patient, the more likely they were to get paid.

For the full story, click here.

Reconciling: Remittance advices should be automatically reconciled 

In a busy practice, invoicing patients quickly is one thing, but having time to reconcile payments is not always a top priority. In a study, we automated the reconciliation process for a client and were able to reduce their reconciliation admin time from 2 hours to 10 minutes*.

For the full story, click here.

*Medicross automatic reconciliation results- June 2015.

Reporting: You can’t manage what you don’t measure

You can’t manage what you don’t measure is an old management proverb that is even more relevant today. Without measurement, it is difficult to spot areas of concern in your practice, as you cannot see what’s getting better and what isn’t. When you do measure your practice’s performance, you can:

• Discover useful trends (from costs and consultation time to billing and bad debt)
• Spot areas of risk.
• Improve efficiency.

For the full story, click here.

Conclusion: RCM matters

The above insights show that RCM is not just a pretty acronym, but something that can make a real difference to your practice. This has been a tough year for the healthcare industry, and 2017 promises to be no easier. Understanding RCM, and making a conscious effort to implement it, will help your practice to thrive in 2017.