July 10, 2023

How Doctors Can Increase Revenue with Efficient RCM

If you’re a doctor, you know how important it is to get paid for the services you provide to your patients. But getting paid is not as simple as sending a bill and waiting for a check. You need to have a solid process for managing your revenue cycle, which is the journey of a patient’s payment from the moment they book an appointment to the final collection of their balance.

This process is called Revenue Cycle Management (RCM), and it’s vital for your financial health and success. RCM involves a lot of steps and tasks, such as:

• Registering your patients and collecting their information
• Verifying their insurance eligibility and benefits
• Capturing the charges for the services you provide
• Coding the claims according to the industry standards
• Submitting the claims to the insurance companies or patients
• Posting the payments you receive
• Following up on any unpaid or denied claims
• Resolving any disputes or errors

Sounds complicated, right? Well, it is. And it’s even more challenging in today’s healthcare environment, where you have to deal with:

More rules and regulations: The healthcare industry is constantly changing, and you have to keep up with the latest laws and policies, such as the Affordable Care Act and HIPAA, that affect your billing and collections process. You also have to comply with the quality and performance measures that determine your reimbursement rates.

• More value-based care: The healthcare system is shifting from a fee-for-service model to a value-based care model, where you get paid based on the outcomes and quality of care you deliver, not just the volume of services. This means you have to align your clinical and financial goals and prove your value to your payers and patients.
• More patient financial responsibility: More and more patients are choosing high deductible health plans (HDHPs), which have lower monthly premiums but higher deductibles and copays. This means they have to pay more out of their own pockets for their healthcare costs. And with the COVID-19 pandemic, many patients have lost their jobs or their health insurance, making it harder for them to afford their medical bills.

These challenges and opportunities make RCM more important than ever for your practice. You need to optimize your revenue cycle to improve your cash flow, reduce your costs, enhance your patient satisfaction, and grow your business.

But how do you do that? How do you transform your RCM from a complex, manual, and siloed operation to a streamlined, automated, and integrated one?

That’s what we’re going to show you in this blog. We’re going to share with you some of the benefits and best practices of efficient RCM, and how you can implement them in your practice.

So let’s get started!

Benefits of Efficient RCM

Efficient RCM can have a positive impact on your practice in many ways. Here are some of the benefits you can expect from improving your revenue cycle:

Improve cash flow and reduce bad debt 

By streamlining and automating your RCM processes, you can reduce the time and resources it takes to collect your payments, and increase the accuracy and completeness of your claims. This can help you get paid faster and more fully, and reduce the amount of unpaid or uncollectible accounts.

Enhance patient satisfaction and loyalty

By providing your patients with clear and transparent information about their financial obligations, and offering them convenient and flexible payment options, you can improve their experience and trust in your practice. This can lead to higher patient retention and referrals, and lower patient complaints and disputes.

Increase staff productivity and performance

By eliminating manual and redundant tasks, and integrating your RCM systems and data, you can free up your staff from administrative burdens and enable them to focus on more value-added activities, such as patient care and engagement. You can also monitor and measure your staff’s performance and identify areas for improvement.

Comply with regulatory requirements and avoid penalties

By staying updated and informed on the latest rules and regulations, and using standardized and compliant coding and documentation, you can ensure that your practice meets the quality and performance standards set by the government and payers, and avoid any audits, fines, or denials.

These benefits can help you boost your bottom line, improve your reputation, and grow your practice. But how do you achieve them? How do you implement efficient RCM in your practice?

Best Practices for Efficient RCM

Efficient RCM is not a one-time project, but a continuous process that requires constant monitoring and improvement. Here are some of the best practices that can help you optimize your revenue cycle and achieve the benefits we discussed in the previous section:

Automate and streamline workflows with RCM software

One of the best ways to improve your RCM efficiency is to use a software solution that can automate and streamline your workflows, from scheduling to collections. RCM software can help you:

• Capture and verify patient information and insurance eligibility
• Generate and submit accurate and compliant claims
• Track and manage claim status and denials
• Post and reconcile payments
• Generate and send patient statements and reminders
• Analyze and report on your revenue cycle performance
• By using RCM software, you can reduce errors, delays, and costs, and increase speed, accuracy, and visibility in your revenue cycle.

Verify insurance eligibility and collect patient payments upfront

Another way to improve your RCM efficiency is to verify your patients’ insurance coverage and benefits before they receive your services, and collect their copays, deductibles, or coinsurance at the time of service. This can help you:

• Avoid claim rejections or denials due to eligibility issues
• Reduce the risk of bad debt or write-offs.
• Improve your cash flow and reduce your accounts receivable.
• Educate your patients about their financial responsibility.
• Increase your patient satisfaction and loyalty.

By verifying insurance eligibility and collecting patient payments upfront, you can ensure that you get paid for the services you provide, and that your patients understand what they owe and why.

Optimize coding and documentation to reduce errors and denials

Another way to improve your RCM efficiency is to optimize your coding and documentation practices, to ensure that you capture all the charges for the services you provide, and that you code them according to the industry standards. This can help you:

• Maximize your reimbursement rates
• Minimize claim rejections or denials due to coding errors
• Reduce the need for claim resubmissions or appeals
• Comply with the quality and performance measures
• Avoid audits, fines, or penalties
• By optimizing coding and documentation, you can ensure that you get paid what you deserve, and that you avoid any compliance issues.

Monitor and analyze key performance indicators to identify areas for improvement.

Another way to improve your RCM efficiency is to monitor and analyze your key performance indicators (KPIs), such as:

• Days in accounts receivable (DAR)
• Claim denial rate
• Clean claim rate
• Collection rate
• Cost to collect

These KPIs can help you measure how well your revenue cycle is performing, and identify any gaps or opportunities for improvement. You can use RCM software or analytics tools to track and report on these KPIs, and use them to make data-driven decisions to optimize your revenue cycle.

Conclusion

RCM is a critical process for your practice, as it affects your financial health and success. However, RCM is not an easy task, as it involves many steps and challenges in the current healthcare environment.

That’s why you need to invest in efficient RCM, which can help you:

• Improve cash flow and reduce bad debt
• Enhance patient satisfaction and loyalty
• Increase staff productivity and performance
• Comply with regulatory requirements and avoid penalties

To achieve efficient RCM, you need to follow some best practices, such as:

• Automate and streamline workflows with RCM software
• Verify insurance eligibility and collect patient payments upfront
• Optimize coding and documentation to reduce errors and denials
• Monitor and analyze key performance indicators to identify areas for improvement
• By following these best practices, you can transform your revenue cycle from a complex, manual, and siloed operation to a streamlined, automated, and integrated one.

If you need help with implementing efficient RCM in your practice, Atlantis RCM is here to help. We have the expertise, experience, and technology to help you optimize your revenue cycle and grow your business.

Contact us today to find out how we can help you increase your revenue with efficient RCM.