How to Turn Your Revenue Cycle Management Process AroundSeptember 25, 2017
The efficiency of the your practice’s revenue cycle can have a critical impact on financial performance, and effective management of the cycle is of utmost importance to your practice. However revenue cycle management within health practices is becoming increasingly difficult, with greater administrative responsibilities and regulatory pressures. This article outlines the problems practices are facing and how to turn the revenue management process around.
The revenue cycle starts when a patient first makes an appointment, through when the they no longer have a balance on their account. The processes from start to finish of the cycle are wide-ranging, from appointment scheduling, to statement processing, and insurance claims. These are all processes that require significant time and administrative resources. Staff are often under pressure to complete these processes quickly in order to remain competitive, which leads to mistakes being made. Practices may benefit from outsourcing the revenue function to a professional speciality-specific team such as Dr. Billing that provides expert physician billing, collection and accounts receivable services. This can help staff focus on their primary objective to provide better care for patients.
A small mistake can throw off finances and lead to major problems within the revenue cycle. For example, using the wrong diagnosis code, or incorrect patient identifier information for a claim can lead to the entire claim being denied. Internal revenue management requires staff to be trained in areas such as the importance of collecting accurate patient data, coding errors, and billing/filing errors. Training requires a significant resource and if it is not executed well enough, inexperienced or under-trained staff can lead to revenue cycle inefficiencies and errors.
Limitations of Practice Management Systems
Technological advances in Practice Management Systems have vastly increased the efficiency of practices, resulting in better workflow and improved patient care. However in-house management of the revenue cycle can still result in communication problems, mistakes, and time wastage occurring. For example busy practices tend to process multiple claims at the same time, and administrators often fail to see high-level trends for the claim. This can result in the same processing errors being made repeatedly.
Transforming the revenue cycle management process requires strategic vision, and may be helped by infrastructure redevelopment. 5 Star Billing Services provides consultancy services to help you address your individual practice’s needs, including advice on integrated software solutions.
Regulatory and Coding Pressures
With government healthcare provisions such as the Health Insurance Portability and Accountability Act (HIPAA) tightening data requirements for claims, a focus on healthcare fraud and compliance, combined with reduced physician reimbursement with Medicare and Medicaid, practices are swamped with changes to compliance and regulations. In addition, the fee coding process is no easy task, with more than 140,000 ICD 10 codes currently available. With nearly 19 times as many codes in ICD 10 than in ICD 9, it is extremely difficult for internal staff to stay on top of regulatory requirements and fee coding.
Practices need a well-trained and experienced billing team who keep informed about industry changes such as HIPAA updates. This can be a big task for internal staff, therefore outsourcing can be a good option.
Getting paid the maximum you are owed and keeping up with payment cycles is incredibly important for a busy practice. Where traditionally practices have relied on administrative staff to navigate the complexities of the revenue cycle, outsourcing the process is becoming widespread for practices. Developing a well-functioning revenue management process can help to turn practice finances around and have a huge impact on the bottom line.