ALANA WILLIAMS

WHAT IS REVENUE CYCLE MANAGEMENT?

The Healthcare Financial Management Association (HFMA) defines revenue cycle as "All administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue." In other words, it is a term that includes the entire life of a patient encounter from creation to payment.

WHY IS REVENUE CYCLE IMPORTANT? Revenue cycle management solutions play a key role in the overall success of a medical center by monitoring the financial stability and activities that keep facilities running smoothly.

THREE MAIN PROBLEMS WITH REVENUE CYCLE Staff has not been properly trained or educated Revenue cycle is like a supply chain; if one person in the chain does their job incorrectly, it will affect the outcome of the rest of the chain. Incorrect data entry (insurance information, patient demographics, etc) impacts the revenue of the office. Lack of communication between staff While the typical office day can be very busy, it’s important that everyone understands their role in the office’s revenue cycle. Therefore, communication between the front office, back office, clinicians and the billing team must remain open in order and is vital to the success of the practice’s financial outcome. Poor workflow Does your staff check patient eligibility and copay amounts before the patient arrives? Do you check for missing charges against your charge slips? How long does it take your staff to follow up on claims? Without an established workflow, your staff can end up missing steps and/or forgetting tasks which ends up in increased errors and more delays to getting paid.

SOLUTIONS FRONT OFFICE Automated patient appointment reminders reduce no-shows and help provider productivity. Insurance eligibility verified electronically can minimize billing delays and denials. Credit/ Debit card processing of co-pays, deductibles or co-insurance payments at the time of the office visit increases the probability that you’ll collect more of a patient’s self-pay balance.

PATIENT VISIT An EMR can document the details of a patient encounter, and capture other relevant documentation that a biller would require to ensure reimbursement. Charge capture functionality can make sure providers input the appropriate diagnosis and procedure codes at the time of visit to send to the biller, who can then easily review the clinical notes to be sure that all codes are accurate

BILLING FUNCTIONS Electronic claims can be submitted in real time directly to a clearinghouse. Claim status tracking, and claims can be scrubbed before they are submitted to payers to check that they meet national and local requirements for medical necessity and comply with commercial claims stipulations. Electronic Payments can be posted automatically to expedite the billing cycle. Key reports can give important insights on both a macro level (e.g. the profitability of your business), and a micro level (e.g. the profitability of a particular procedure), and help practices stay apprised of key RCM indicators

PERFORMANCE IMPROVEMENT

IMPROVING PERFORMANCE aTheorem solutions has put together a performance improvement model that works in conjunction with revenue cycle management aTheorem’s practice improvement model hones in on areas such as: Right-sizing your staff Identifying allocating responsibilities Crafting strong job descriptions outlining staff roles and responsibilities While it sounds simple, strong job descriptions can help counteract and prevent issues that are directly related to the revenue cycle process

TOOLS AND TRAINING Equip staff with the necessary tools and training For instance, automated insurance verification or automated appointment booking might help front- desk staff spend more time interacting with patients when they present for appointments. The goal here is to really drill down to fine tune the process and to if there are any tools and techniques that may be available to help with that process.

CONCLUSION Your reimbursements on claims filed and the money paid out of pocket by patients are the basis of your revenue cycle. The extent to which you effectively manage your payment processes and have a handle on collecting payments that are past due is an indicator of your practice’s financial health. Having appropriate technology, adequate workflow and key billing processes are important steps on the path toward a prosperous and efficient practice.