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Revenue Cycle Management 101: 3 Key Focus Areas

By: Jennifer Gibson | April 6th, 2018

Revenue Cycle Management 101: 3 Key Focus Areas Blog Feature

There are numerous external factors that can impact a specialty practice’s ability to remain financially strong—shrinking payer reimbursements, evolving regulatory requirements and the exploding number of high deductible health plans, just to name a few. A key to navigating these evolving dynamics is a high-performing revenue cycle—one that is not only efficient but also effective at capturing all the revenue that a practice has earned.

3 Key Focus Areas—Where to Look for Opportunity

Unfortunately, as specialty practices focus on delivering top-notch clinical care, solid revenue cycle performance can slip down the priority list. Here are 3 top places to focus on to boost financial outcomes while maintaining a primary focus on delivering superior clinical care:

1. Patient collections.

As more patients are selecting high-deductible health plans, they are being held responsible for larger portions of their healthcare bills. Whereas collecting money directly from patients used to be a lesser priority for providers, with the increase in patient payments, it has become paramount to have a defined patient collections program in place.

Practices should focus on training staff on how to consistently and compassionately ask for money, and have processes and technology that make it easy for patients to pay. This might include online payment options, credit card on file solutions, payment plans and so on.

2. Denials prevention.

Providers can leave money on the table if they fail to effectively respond to payer denials, or take steps to prevent them in the first place. While a practice may use work queues to handle this issue, this tactic is often not enough.

Instead, they should use solutions that verify coverage upfront and eliminate coding and billing errors. They should also have easy access to analytics and establish comprehensive programs that dig into root causes and identify mitigation strategies. These advanced processes and procedures allow the practice to shift away from merely reacting to denials and embrace a more proactive approach.

Although a practice may be able to set up a denials prevention program in house, innovative technology and specialty revenue cycle management (RCM) vendors can help with this effort, which can ease the burden on already overloaded practice staff.

3. Integrating clinical and RCM technology.

Practices that are using a specialty-specific electronic health record (EHR) system that reliably captures clinical information and ensures accurate coding have an advantage.

Seamlessly integrating this solution with their Practice Management (PM) and RCM technology will ensure a more automated flow of insurance verification, exam documentation, coding, billing and payment processing with less opportunity for mistakes.

When practices implement clinical and financial systems that work well together, they can realize better information exchange and streamlined claims management processes.

The Results

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By implementing the above mentioned 3 key focus area improvements, providers can achieve healthy end-to-end revenue cycle performance. Not only will this help them remain financially viable, it will also put them in an advantageous position to tackle new payment models and other emerging trends in the healthcare space.

To learn more about revenue cycle optimization, keep an eye out for upcoming blogs in our RCM series that will dig deeper into related topics plus provide tips and actionable strategies to consider. Stay tuned!