Financial success of medical practices can be ensured with proactive management of the revenue cycle. It can help them avoid lost revenue opportunities, prevent frauds, reduce rejected claims and support compliance efforts.

Revenue cycle should be structured for optimizing yield and reducing the cost for payment collections. It should provide timely insight into the core processes and issues related to payer performance. Health systems can use this information to address areas that result in minimal cash flow. It can also be used for avoiding unwarranted payer delays.

  • As per current trends, hospitals lose around three to five percent of their net revenue due to lack of adequate RCM processes

With the right RCM solution, it becomes easy to enhance long term viability and financial health of a practice. It also leads to the following:

  • Cleaner claims
  • Improved efficiency throughout the practice
  • High quality patient information
  • Enhanced protection of reputation

Hospitals and private practices are making an attempt to combat issues related to dipping profits, fewer patients and rising debt with investment in RCM technology. However, they need to have the required infrastructure in place for measuring and monitoring results through leading indicators across their revenue cycle. They need to focus on certain areas, including the following.

Enhancing patient experience: Practices should offer a stress-free experience to patients during the registration and appointment scheduling procedure. This will set a positive tone and help enhance patient experience.

Improvising clinical documentation: Keeping precise clinical records is vital for maximizing reimbursement. Providers can introduce a clinical documentation improvement program that will help them enhance billing procedures and strengthen their revenue cycle.

Maximizing collectability: Practices need to develop better capabilities to measure how reimbursement for each payment model will get impacted by clinical outcomes. Collaboration between departments will have to be strengthened to link quality and outcomes, minimize denials and enhance reimbursement.

If the process of revenue cycle is not executed in an appropriate manner, it can have serious financial ramifications. Providers will need to follow the steps mentioned below to identify performance improvement opportunities. This will help them prepare for the future challenges.

  • Assess current state of the revenue cycle
  • Identify key challenges associated with RCM
  • Find strategic solutions
  • Finalize the best technology or processes required for tackling the challenges

RCM can be quite complex to handle if providers focus more on cost cutting rather than improving the revenue cycle. The right mix of people, process and technology is necessary to manage this cycle efficiently. Many practices hire billing companies like to manage their revenue cycle. MBC has a strong team of experienced coders and billers who are well-trained in handling RCM challenges for hospitals and practices.

Considering the payments cuts, stringent healthcare reforms and regulations are to be introduced in the near future. Providers will need to spend on staff, training and technology. This will be vital to ensure that each part of the revenue cycle works efficiently.

Published By - Medical Billers and Coders
Published Date - Jul-18-2014 Back

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