Top Revenue Cycle Management Best Practices and How To Optimize Yours

Revenue cycle management allows healthcare providers to maximize an organization’s financial performance. The revenue cycle in a medical practice covers everything from verifying insurance information to ensuring accurate coding, successful claim submission, and timely payments.

Revenue cycle optimization protects the financial stability and efficiency of your practice. However, achieving this can be challenging when you face ever-changing healthcare regulations from insurers, strict claims requirements, and high outstanding balances from patients.

Read on to learn about top revenue cycle management best practices to reduce your denial rate and get paid faster for optimal revenue generation.

Key Metrics for Measuring RCM Performance

The first step in improving your revenue cycle performance is gathering data to measure your performance. Before measuring revenue cycle efficiency, you must fully understand the revenue cycle management process.

The seven standard steps in the revenue cycle go from pre-registration to patient payment collections. The revenue cycle can be broken down into 10 more detailed primary steps, though, as described below:

• Patient registration: Your team ensures insurance eligibility.
• The patient’s appointment: The healthcare provider documents codes for the charge.
• Medical billing submission: Your billing staff members send the claim to the clearinghouse, where it may be rejected or accepted.
• Claims management: Your team follows up on inquiries submitted once every 30 days.
• Remittance processing: The payer sends reimbursement, partial payment, or denial with an explanation citing insurance regulations.
• Claim denials and appeals: Your billing team corrects and resubmits claims.
• Payment posting: The reimbursement reaches your billing software.
• Billing statements: You send the remaining medical bills to patients.
• Patient follow-ups: You remind patients of their financial responsibilities via text, email, phone call, etc.
• Payment fulfillment: The patient fulfills their financial responsibility.

Now that you understand each step of the process, you may have an idea of why different parts of the revenue cycle may hit roadblocks. To track your key performance indicators, we recommend the following metrics:

Days in Accounts Receivable (AR)

Days in accounts receivable looks at how long your healthcare organization takes to collect payments (from patients or insurers). Measuring and tracking AR days allows healthcare professionals to ensure they’re getting paid in a timely manner for cash flow efficiency. Here are some revenue cycle management best practices for reducing AR days:

• Capture robust patient insurance details up front
• Implement automated claims scrubbing systems to prevent errors
• Create proactive strategies to handle denied claims
• Offer a flexible payment process for patients
• Leverage billing technology

Clean Claim Rate

Your clean claim rate measures how many of your claims are processed correctly for successful payment from the insurer. Maintaining a high clean claim rate helps you maximize revenue.

You can ensure accuracy and reduce rejections with claim scrubbing. We recommend using automated billing software to identify common manual errors before submitting claims.

Denial Rate

The denial rate tracks the number of denied claims. A high number of denials means lost revenue, poor efficiency, and an inadequate revenue cycle. Monitoring denial rates can identify areas needing back-end optimization, such as manual processes that could be automated to reduce errors.

RCM Best Practices

So, how can you be a successful revenue cycle manager? You need to understand the basic RCM best practices if you want to modernize claims processing at your facility.

Let’s look at the five key areas of revenue cycle improvement for healthcare organizations:

Front-End Processes

Accurate patient registration and insurance verification prevent issues down the line. Digital forms and online scheduling tools streamline front-end processes for a better patient experience while helping you capture the necessary patient information for efficient payments for services rendered.

Charge Capture and Coding Accuracy

All provided services must be accurately documented in patient care notes and coded correctly to prevent revenue leakage. To keep your team up to date on accurate medical billing codes, you can implement ongoing training and various tools.

Timely and Accurate Claims Submission

Efficient and accurate claims submission allows for faster revenue collection, but this is easier said than done. Many healthcare organizations outsource to numerous third-party providers for different revenue cycle management functions, leading to delays. By opting for a unified automated billing platform, you can ensure accuracy and timeliness in your claims.

Effective Denial Management

You can identify patterns for improving revenue collection by tracking and analyzing denials. For example, you may discover that one of your providers consistently documents their coding of services rendered incorrectly. After discovering this, you could focus on additional staff training to improve revenue cycle management moving forward.

You must also be prepared to appeal and overturn denied claims in an efficient manner.

Patient Billing and Collections

To improve revenue cycle management, healthcare organizations must also focus on offering patients clear billing statements and convenient fulfillment options. Here are some proactive collection strategies for healthcare revenue cycle optimization that can boost the patient experience as well:

• Offer clear and upfront cost details prior to appointments
• Prompt patients with text-to-pay links
• Provide multiple payment options
• Offer financing options
• Streamline billing with the right software

Leveraging Technology To Optimize Revenue Cycle Management

Technology is key when implementing revenue cycle management best practices. Here are some popular options:

Practice Management Software

Comprehensive practice management software offers billing tools to help you improve revenue cycle management while covering your communication needs, patient marketing, and more. We recommend selecting RCM software that syncs with your existing CRM while offering robust features to maximize revenue.

Automated Reminder Systems

Automated text and email reminders reduce no-shows and cancellations, helping you cut down on missed revenue. You can also send automated messages to remind patients of their bills, ultimately automating your billing process.

Data Analytics and Reporting Tools

Data and reporting tools allow you to easily track key performance indicators and view RCM efficiency over time. Comprehensive reporting can also help you learn how to generate more revenue through billing efficiency.

Continuous Improvement in RCM

Beyond optimizing the 10-step revenue cycle, you can take the following steps to see continual improvements in your practice efficiency and revenue generation:

Staff Training and Education

Continual staff training on RCM processes and software ensures minimal mistakes and optimal efficiency. Your staff must stay updated on the latest industry regulations.

Regular Audits and Assessments

Regular audits can help you identify and address inefficiencies. We recommend claims scrubbing and software assessments on a routine basis.

Keep Learning How To Book Revenue Cycle Efficiency With Weave

Now that you know the latest revenue cycle management best practices and automation tech for practice efficiency, you can ensure the financial health of your medical practice. Watch Weave’s webinar today on increasing patient engagement to gain deeper insights into effective RCM strategies.