The healthcare industry has seen a number of changes in the recent past. Most of these changes have affected the reimbursements and revenue cycle of medical practices. While the insurance programs have started reducing the reimbursements for physicians, third party payers charge a negotiated fee-for-service. These factors result in reimbursements less than 100% of the charges for the physicians. Therefore, medical practices are struggling to improve their revenue cycle management (RCM) process. The following is a start to end guide for improving the RCM process.
1. Patient Appointment Scheduling
A revenue cycle begins with the appointment scheduling of a patient. While collecting the patient information during scheduling, the staff should keep a checklist ready so that no important details of the patients are missed out. When the patient provides his insurance details, the staff should verify it and let the patient know if their hospital falls under the insurance network or not. The patients should also be informed on other additional things like co-pays at the time of visit, the registration work that needs to be done, bringing along their medical history and other related data that they should bring at the time of appointment along with the time at which patient is supposed to come to complete a certain paperwork which may be necessary.
2. Patient Registration Process
After the first patient scheduling, every visit is updated in the revenue cycle. Basic information like demographics and the insurance details should be confirmed and changes, if any should be updated in the patient database. Regular patients need not fill this form at every visit; however, they should fill it at least once a year by themselves, i.e. without depending on the HER or the front desk staff.
Similarly, every new patient should fill the form themselves on their first visit after giving out the initial information during the appointment scheduling. Upon completion of the same, the billing staff should review it for completeness. This not only prevents mistakes but also saves the patient from visiting the facility from time to time for various paperwork.
3. Co-Payments Information and Collection
In case of Medicare patients, the patient needs to fill Medicare Secondary Payer questionnaire during the registration. It is necessary to update this questionnaire every time the patient visits the facility. At some practices, the co-pays are collected after the patients visit the provider. However, if they are collected during the registration and before visiting the provider then the patient in-flow can be greatly improved.
4. Beforehand Authorization
If the medical facility is a very large and busy place then a staff can be assigned specially for completing the authorization and pre-certification work depending on the type of patient influx.. This is especially useful in case of orthopedic, neurology and surgical practices wherein the paperwork is slightly longer.
5. Documentation of Records
Maintaining records (electronic or handwritten) in a systematic way combined with proper documentation is a good practice. There should be a written policy addressing important issues like date entry, signing, the timeline for completing a patient’s record, entering the diagnosis, updating the performed procedures (such as immunizations, lesion removals,etc.), after each visit..
The policy should also address factors like who is responsible for the documentation, and a general set of guidelines, and using a template for each of these would maintain uniformity.
The above-mentioned pointers will help with systematic documentation and a quick run-through when patients visit the facility. This speeds up work and makes it easier to maintain a steady patient inflow.
FAQs
1. Why is patient appointment scheduling crucial for Revenue Cycle Management (RCM)?
Appointment scheduling is the first step in the revenue cycle. Accurate collection of patient information, insurance verification, and communication about co-pays and necessary documentation ensure smoother workflows and reduce delays in billing and reimbursements.
2. How does patient registration impact the RCM process?
Accurate and up-to-date patient registration ensures that the billing staff has the correct demographic and insurance details. This reduces errors, minimizes claim rejections, and improves the efficiency of the revenue cycle.
3. Why should co-payments be collected during patient registration?
Collecting co-pays during registration streamlines patient in-flow, reduces follow-ups for payment collection, and improves cash flow for the medical practice. It also enhances transparency for patients regarding their financial responsibility.
4. What is the role of authorization and pre-certification in RCM?
Authorization and pre-certification ensure that the required approvals from insurance providers are obtained before services are rendered. This is particularly important for specialized practices like orthopedics and neurology to avoid claim denials and delays in reimbursements.
5. How does proper documentation benefit the RCM process?
Systematic documentation helps maintain accurate patient records, ensures timely billing, and reduces errors in claims. Policies addressing data entry, diagnosis updates, and procedure documentation streamline workflows and support efficient claim submissions.
