REVENUE CYCLE MANAGEMENT
Revenue Cycle Management is the method of managing claims processing, payment, and revenue generation. This includes everything from determining the patient’s eligibility, collecting their copay, coding the claims, collecting payments, tracking the claims, and following up on denied claims. As a critical part of any practice, the entire revenue cycle and account receivable process must be managed efficiently.
POINTERS TO POORLY PERFORMING REVENUE AND ACCOUNT RECEIVABLES
A key element to a slowdown in cash collections is that third party insurance companies, Medicare avoids paying claims by requiring that invoices comply perfectly with their requirements. To further burden the provider, they change these conditions at will.
Also, Practices that need an account receivables turnaround may lack internal controls (i.e., the ability of the patient financial business office to control itself), low morale, anxiety on the part of the staff, and a staff that lacks the skills and training necessary to perform effectively. Other contributing factors include; an inadequate collaboration between revenue cycle departments.
ACCOUNT RECEIVABLES CONSIDERATIONS FOR PROPER REVENUE CYCLE MANAGEMENT
When embarking an account receivables turnaround, if you believe that you need drastic action, you first need to have a plan (and you’ll always know what the next step needs to be). This is very important because the busier you’re, the more you need to plan. The next important consideration is to determine if you’ve enough resources to reach your cash and account receivable objectives.
Engaging the assistance of a revenue cycle consultant is another consideration in that most of these individuals are seasoned and have no bias that may affect the decision-making process. As a result, they make the required decisions regardless of the popularity of those decisions or political implications. Revenue cycle consultants can assist practices to re-design ineffective workflows, procedures, and processes while spending considerable time in training the staff. These experts concentrate on managing operational aspects relating to change without becoming unnecessarily entangled in the internal battles that can often derail turnaround efforts.
Guidelines Needed To Achieve Adequate Account Receivables and Revenue Management.
- Create a sense of urgency to all staff that business, as usual, must change: Once you decide to go forward, you’ve to be determined and pursue effective implementation of identifying new methods and systems.
- Do not restrict your attention to Patient Accounting alone: Although patient accounting is where it all ends up, do not neglect the other components of the revenue cycle in performing your assessment and charting a roadmap for change. Patient Access, ancillary departments, and Health Information Management (HIM) are major players in the revenue cycle, and ineffective operations in these areas can have a significant impact on the management of the accounts receivable.
- Insist on a top-to-bottom operational review, including an analysis of billing systems, billing practices, staffing methodologies, staffing levels, and comprehensive accounts receivable analysis: This should be the first point of call in improving revenue cycle performances. Interview all management personnel within the business office and all staff members during the fact-finding effort.
- Communicate your vision and set goals for everyone: Be sure you spend considerable time educating the staff on what expectations will be like after the implementation. Make them part of the process by keeping them informed every step of the way because people are warier of what they do not know than what they do know.
- Reduce denials: Another main area in any turnaround program should be the implementation of an effective denial management program. Many health care financial managers do not have a good working understanding as to the reasons for their payment denials. There is every need to have a specific policy and procedures surrounding the handling of pre-certification and authorization denials. More significantly, a monitoring team, process, and system will be required to track the causes on an ongoing basis and continually take steps to eliminate them.
- Eliminate all billing backlogs: Identify those accounts within the accounts receivables that have a very low probability of collection. If you believe that adequate internal resources are, or can be made available, organize the accounts to be worked in descending balanced order, offer overtime if needed, and implement a concentrated follow-up effort.
Finally, finding solutions to a troubled medical revenue cycle is no easy feat. Practices first need to determine precisely what is wrong with their revenue cycle and then have a road map that will achieve the necessary changes while maintaining cash flow in the interim. Whichever method you decide to apply during the account receivable turnaround attempt, remember that proper planning and allocating the right resources to produce maximum performance are paramount.