First Steps in a Successful Revenue Cycle Management Process

In a previous post we defined Revenue Cycle Management (RCM) as the financial process that health care practices and providers use to track patient care episodes. At pMD^®, we believe a successful revenue cycle starts with obtaining accurate patient demographics at the point of patient care or during registration. Making sure a patient is set up in your system with complete and correct information, including insurance coverage, is crucial to ensuring the provider is reimbursed in a timely fashion.

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Impact of Patient Demographics on Medical Billing

Patient demographic data consists largely of name, address, date of birth, insurance information, and pre-authorization numbers. Errors in this information can lead to claim denials and delays in payment, negatively affecting your cash flow. Research shows that up to 22% of denied claims are due to patient demographic and insurance eligibility issues, which is the top cause of denials according to Change Healthcare’s 2022 Revenue Cycle Denials Index. Inaccurate patient information can result in denied claims, higher administrative costs, and even potential legal consequences.

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Benefits of Using Workflow Automation to get Verified Patient Demographics

Every practice seeks to obtain accurate patient demographic information but is often hindered by the manual labor involved with obtaining and verifying this data, especially when physicians round at multiple hospitals. Each hospital typically has a separate electronic health record (EHR) for a patient that it keeps within its own system, making it more difficult to obtain complete patient records when processing the charge. Physicians try to work around the data silos that different hospitals create by uploading pictures of patient face sheets into their charge capture software. However, it leads to hours spent every day manually copying patient information from the uploaded photograph into the practice management or billing software. Workflow automation streamlines the process by automating many of the manual tasks, which can lead to the following benefits:

• Reduced Data Entry Errors: Automated data extraction and validation can minimize manual data entry errors, lowering the risk of claim denials. Some more advanced systems can even use AI to recognize and correct inconsistencies in demographic information.
• Improved Insurance Verification: Workflow automation can facilitate real-time insurance verification, ensuring up-to-date coverage information before rendering services.
• Accelerated Claim Submission: When you have an automated solution to help acquire accurate patient demographics for your practice, claims can be submitted faster, resulting in quicker payments and fewer timely filing denials. An AI can also work behind-the-scenes to help identify and resolve issues before claim submission, further reducing the chances of denials and delays.

Choosing an RCM partner that leverages software to automate manual processes encourages your practice to grow and scale more quickly. Automation enables you to redirect employees towards other revenue-generating tasks or reduce your staffing costs overall. By streamlining the workload especially around patient demographics, your practice benefits from fewer denials, increased cash flow, and more time to spend on other aspects of patient care.

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How pMD^® Can Help

Here at pMD^®, our mission is to streamline and optimize as many areas of the patient care episode and the revenue cycle as possible. Through our advanced, end-to-end practice management and revenue cycle solutions, we’re able to help practices consolidate vendors, reduce costs, streamline workflows, improve patient care and satisfaction, and collect your maximum reimbursement quicker.

Not sure what a vendor could do to improve your financial metrics? Contact pMD^® for a no-commitment financial impact analysis by our team of healthcare RCM experts free of charge!

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