The financial process health care facilities and groups use to submit claims to an insurance provider is known as your Revenue Cycle. This can begin well before a patient steps foot in the door and can continue past the final payment of a balance.
What is Revenue Cycle Management?
Revenue Cycle Management (RCM) refers to the process of identifying, collecting, and managing the practice’s revenue from payers based on the services provided. A successful RCM process is essential for a health care practice to maintain financial viability and continue to provide quality care for its patients.
The Revenue Cycle can look a little something like this:
1. Before a patient arrives for inpatient or outpatient procedures, collect any pre-registration information, such as insurance coverage.
2. Collect subsequent patient information during registration to establish a medical record number and meet various regulatory, financial, and clinical requirements.
3. Complete charge capture, which refers to rendering medical services into billable charges. This is what pMD has specialized in for over twenty years!
4. Have a coder review diagnoses and procedures.
5. Submit charges of any billable patient interactions to insurance companies.
6. Afterwards, the billing department can determine patient balances and collect payments.
This is a process where there are a lot of opportunities for hiccups and stalling. What if a patient’s demographic or insurance information was transcribed incorrectly, or a procedure is billed that doesn’t fit coding criteria? What happens when a claim is denied? How often is a patient left completely in the dark until the moment they get a massive bill in the mail?
Here are some ways to mitigate potential hurdles and ensure that your RCM is benefiting your practice as well as your patients.
1. Maintain a clear line of HIPAA-compliant communication between different individuals in your Revenue Cycle. Ensure that if needed, it’s simple and efficient to verify the information required and receive updates as necessary.
2. Design a patient-oriented experience that prioritizes transparency. When you’re registering a patient, establish expectations with them, and keep them informed on what your staff is doing.
3. If your practice is verifying a patient’s insurance before a procedure, you can let them know if they need to pay a copay, or if they should expect to be billed a coinsurance. Confirming that their insurance will cover a high-cost operation will make it easier for your practice to collect payment, and put your patient’s mind at ease.
4. Provide relevant literature to patients who may require financial assistance. Ensure that they know their options regarding payment plans and if they can apply for charity or hardship.
5. Communicate clearly during the billing process, and ensure that a patient understands what responsibilities they have, whether they’re financial obligations or a need for documentation or additional paperwork.
6. Finally, you’ll want to make sure that your billing team has contact with the payers. Prompt, efficient follow-up is the best way to mitigate denied claims and decrease the turnaround time between submission and payment.
With these tools at your fingertips, you can ensure that your practice is run in a way that is both financially successful and compassionate to the needs of your patients.
To find out more about pMD's suite of products, which includes our charge capture and MIPS registry, billing services, telehealth, secure messaging, clinical communication, and care navigation software and services, please contact pMD.