How Revenue Cycle Management helps Healthcare Leaders Simplify their Practice?

December 16, 2022

The healthcare system has shifted its dynamics drastically in the last five years. Now, the in-person visit has changed into an e-visit, and remote services, disregarding the destination boundaries, are the new normal.

“Today, in many cases payments make up 33% government, 33% insurance companies and 33% patients which vary from practice to practice. Providers are struggling to cope with getting their arms around the fastest growing payer which is the patient.”

Medical Economics

According to Medical Economics, the main challenges faced by practices in claim reimbursements include:

• Constant shifts in payment responsibilities,

• Higher insured patient’s deductibles, and

• Transparency issues across multiple-channel systems

The payment landscape has momentously evolved over the years owing to the recent pandemic. Small practice physician owners must focus on the business and health aspects of running a private practice.

Pinning every percentage of revenue for rendered care services requires efficiently collecting payments and reducing claim denials. Thus, healthcare leaders need to create and follow a pattern to streamline work, revenue, and tasks while keeping an emergency action plan on standby.

Revenue cycle management (RCM) is a rapidly evolving, multi-billion-dollar market with significant complexities. Healthcare leaders must acknowledge the new way care is delivered and paid for while staying prepared for the next round of evolution.

Here are some ways healthcare leaders can use RCM to simplify their practice in the longer run.

Maintain Synergy Between Front-End and Back-End Workers

There is an age-old disconnection between the front-office and back-end staff when it comes to the RCM system. One reason is that the front desk deals with the patient directly while the back-office team handles tasks like claim submission, code generation, follow-ups, and billing statement management.

On the contrary, the revenue cycle follows steps from initial patient registration to the final reimbursement for their rendered service.

Healthcare leaders should ensure a smooth transition from initial documentation to payment collection. Technology innovated solutions can help resolve this battle by:

  • Online appointment scheduling
  • Automated follow-up reminders
  • Digital rescheduling of no-shows

Maintain Healthcare’s Management SOP

Despite patient registration, validation, code integration, appointment scheduling, and eligibility verification being crucial to healthcare practice, they can be automated and streamlined, reducing human staff’s workload.

To stay on top of the ever-changing healthcare interface, leaders need to standardize procedures and protocols to be followed by all personnel and branches of their healthcare organization. The majority of larger hospitals and clinics maintain a rule book to go by; however, smaller practices ignore this essential action.

Creating an action plan for all healthcare professionals and situations might take time initially, but it will save your practice's reputation in the longer run.

CareCloud Concierge has a dedicated team of care providers who assist in staff's technical and clinical onboarding.

Collect Financial Details from Patient upon Registration

In the case of self-pay billing, guarantee billing details are documented and verified during initial registration. Provide multiple payment options to patients and cover finances alongside care rather than leaving it for the end collection.

Also, discuss self-pay limits with the patient to avoid chargeback denials later. It is both financially advantageous for the practice and increases patients' trust in your care, making them return and give positive reviews.

Digital Insurance Verification Upon Patient Enrolment

Digitally enroll and confirm all insurance plan details from the patient up-front at the time of registration.

Verify the plan rules and confirm if rendered services are included in the patient’s plan up-front. Furthermore, patients should be carefully informed of their financial responsibility, and all payment details must be cross-checked upon initial clinical enrolment of the patient.

Automate Patient Authorizations

Recognize that revenue cycle management is a complete process accompanying multiple outlooks. Hence, you might need more than one element to generate the desired results for your practice. If automated processing systems work alongside human personnel and learn the technicality simultaneously, practices can thrive beyond imagination.

CareCloud Concierge can efficiently integrate with electronic health records and practice management systems that make the practice’s workflow effortless.

Also, its integrated AI-charged robotics and auto-delivered tasks unite the revenue cycle. CareCloud revenue cycle management is an all-in-one system that auto-checks patient authorizations, claim submission errors, and denials. Thus, saving every missed penny to reclaim lost revenue within the practice.

Shifting Work to Patient-value-first Approach

Patients are increasingly becoming the new payer as they prefer out-of-pocket charges. All these concerns highlight the resolution – keeping the patient first.

Financial communications should be made up-front with calmer human interaction to secure patients initially. This way, patients better commit to the care plan and may deliver their concerns openly, benefiting the caregiver to remove all care-delivery restrictions.

CMS has also announced the shift of healthcare towards a value-based care delivery model. To generate more revenue, practices need to reevaluate their current practices fairly and fill the gaps by leveraging support from healthcare IT experts.

Conclusion

This guide explained how revenue cycle management (RCM) could help healthcare leaders simplify their medical practice. If you are looking for a comprehensive RCM solution, CareCloud Concierge is your best option. Our expert billing specialists will handle claim submission, payment posting, payer follow-up, charge entry, patient billing, claims denial management, and so much more. So, what are you waiting for? Get our revenue cycle management services now and boost your overall profitability.