Strategies to Improve Your Bottom Line With Revenue Cycle Management 

Revenue cycle management, or RCM, is the process of managing a healthcare organization's money well, from registering patients to getting paid. It is essential for organizations to have an efficient RCM system in place in order to maximize their revenue and minimize payment delays. Here are some RCM strategies that can help improve your bottom line.

Implementing Electronic Health Records (EHRs)

Implementing EHRs can be a key way for healthcare organizations to improve their revenue cycle management. The following are subheadings that explain how implementing EHRs can improve RCM:

Streamlining Patient Registration and Eligibility Verification

EHRs can significantly reduce the amount of time and effort required for patient registration. With EHRs, patients are able to complete their registration forms online prior to their visit, allowing healthcare organizations to verify insurance eligibility and collect all necessary information with an automated process. This eliminates the need for paperwork and manual data entry, both of which can be time consuming and error-prone.

Improving Charge Capture Accuracy

By giving real-time access to patient records like medication lists, diagnosis codes, and treatment plans, EHRs can help make sure that all billable items are correctly recorded. This can cut down on coding and billing mistakes and make sure that all items that can be billed for reimbursement are.

Enhancing Claims Submission and Processing

EHRs can improve claim submission and processing through the automation of the coding and billing processes, reducing errors and improving the speed of reimbursement. EHRs can also provide real-time access to claim status, allowing staff to track and follow up on submitted claims more efficiently.

Automating Payment Posting and Reconciliation

EHRs can automate the payment posting process by automatically posting payments received from insurance providers and patients, reducing errors and ensuring that recorded patient payments are accurately applied to outstanding balances. EHRs can also be used to automate the reconciliation process, which makes sure that all payments are accounted for on time.

Increasing Data Analytics Capabilities

EHRs can give healthcare organizations real-time access to patient data, which lets them look at patient demographics, diagnoses, and treatments to find trends and patterns in how people use healthcare. This analysis can help organizations identify areas for improvement and optimize their revenue cycle management processes.

Utilizing Data Analytics to Improve RCM Processes

Using data analytics can be a good way for healthcare organizations to improve their revenue cycle management optimization. By looking at how a patient access data and trends in how healthcare is used, organizations can find areas to improve timely payments and come up with plans to make their RCM processes work better. This may include:

Identifying and Addressing Claim Denials

Data analytics can be used to identify patterns in claim denials and develop strategies to address them. This may include assessing coding accuracy, ensuring accurate eligibility verification processes, or improving payment collection methods.

Improving Charge Capture Accuracy

By analyzing charge capture data, healthcare providers can develop strategies to improve accuracy, such as implementing real-time charge capture software or providing additional training to staff. This can help make sure that all items that can be billed are correctly recorded for reimbursement, which lowers the chance of losing money.

Reducing Days in Accounts Receivable

By analyzing data on days in accounts receivable, healthcare organizations can develop strategies to reduce delays, such as automating claim processing or improving follow-up procedures for denied claims. This can help decrease the amount of time it takes for payment to be received, improving cash flow and reducing the risk of bad debt.

Optimizing Revenue Cycle Management Processes

Data analytics can give healthcare organizations a full picture of their healthcare revenue cycle management process, including key performance indicators like charge capture rates, claims processing times, and days in accounts receivable. The results can be used to develop strategies for optimizing the overall performance of their RCM processes. 

Improving Patient Outcomes

By looking at this data, healthcare organizations can come up with specific plans to improve patient outcomes, like putting in place patient education programs or giving patients with long-term conditions more help. This can help to improve patient satisfaction and reduce the likelihood of medical errors, resulting in better outcomes for patients.

Implementing Charge Capture Automation Tools

Implementing tools that automate charge capture can be a good way for healthcare organizations to improve their revenue cycle management. The following are the ways that implementing charge capture automation tools can improve RCM automation:

Improving Accuracy and Efficiency

By automating the capture of charge codes, tools for charge capture automation can cut down on mistakes and omissions that can lead to payments being denied. This can also help staff process charges more efficiently, reducing the time and effort required to complete the charge capture process.

Streamlining Billing and Reimbursement

Charge capture automation tools can also streamline the billing and reimbursement processes by automating the submission of charges to insurance providers and tracking the status of claims. This can help reduce delays and improve overall revenue cycle performance.

Enhancing Compliance

By automating the capture of required documentation and codes, charge capture automation tools can help healthcare organizations make sure they are following regulations and internal policies. This can reduce the risk of penalties or fines for noncompliance.

Improving Revenue and Cash Flow

Healthcare organizations can improve their cash flow and revenue stream by cutting down on the time it takes to manually capture and submit charges. Automating charge capture can also reduce the risk of lost revenue due to incorrect coding or missed charges.

Increasing Visibility and Reporting

Charge capture automation tools can provide healthcare organizations with real-time access to charge capture data, allowing staff to monitor and track key performance indicators such as charge capture rates and days in accounts receivable. 

Conducting Regular Audits and Assessments of RCM Processes

Audits and assessments of revenue cycle management (RCM) processes done on a regular basis can help healthcare organizations find areas to improve and improve their RCM. Here are some strategies for regularly auditing and evaluating RCM processes to improve overall revenue cycle management:

Identifying Errors and Inefficiencies

By reviewing claim data, staff workflows, and documentation procedures, healthcare organizations can identify opportunities to reduce errors and streamline processes, such as by improving training or implementing new technologies.

Ensuring Compliance

By auditing and evaluating RCM processes on a regular basis, healthcare organizations can make sure they are in line with regulations and internal policies. These audits can find places where policies or procedures aren't being followed correctly, like when staff don't use the right coding rules or don't write down accurate information about patients. Auditors can also determine if the current RCM system is meeting the organization’s needs.

Enhancing Financial Performance

By looking at their billing and reimbursement processes, healthcare organizations can figure out where they might be missing billable items or not getting paid on time. This can help organizations make informed strategies for improving financial performance and maximizing revenue.

Improving Data Analytics Capabilities

By reviewing data collection and analysis procedures, healthcare organizations can identify opportunities to improve data accuracy and completeness and develop strategies for using data analytics to inform revenue cycle management strategies. This can help organizations more accurately measure and track performance, identify areas for improvement, and take corrective action.

Using Data to Improve Patient Satisfaction

Auditing and assessing RCM processes can also reveal opportunities to improve patient satisfaction. This includes identifying opportunities to streamline processes, reduce wait times, and provide better communication with patients throughout the revenue cycle. This can help healthcare organizations to both improve patient satisfaction and maximize revenue.

Case Studies or Examples of Successfully Implemented RCM Strategies

Here are a few examples of successful RCM strategies implemented by healthcare organizations:

Luke's Health System

St. Luke's Health System, a non-profit healthcare organization based in Idaho, implemented a revenue cycle management strategy that focused on improving the patient's financial experience. They offered online bill payment options, implemented a price estimator tool, and provided patients with easy-to-understand financial communication. This resulted in a 42% increase in online bill payments, a 26% increase in price estimator tool usage, and an improvement in patient satisfaction scores.

Mercy Health

Mercy Health, an Ohio-based non-profit healthcare organization, put in place a centralized billing system that made billing and reimbursement more accurate and faster. They also put in place a charge capture solution to make the charge capture process less prone to mistakes. This caused net patient revenue to go up by 5.5% and claim denial rates to go down by 13.5%.

Children's Hospital of Philadelphia

The Children's Hospital of Philadelphia (CHOP) put in place a strategy for revenue cycle management that aimed to improve its ability to analyze data. They developed a data warehouse that collected data from various sources and used advanced analytics to identify trends and opportunities for improvement. This resulted in a 5% increase in net patient revenue and a 20% reduction in the average days in accounts receivable.

University of Utah Health

The University of Utah Health put in place a strategy for managing its revenue cycle that aimed to lower the cost of collecting money. They made a predictive analytics model that helped them find patients who were likely to not pay, and then they put in place strategies to get those patients to pay. This caused collection costs to go down by 50% and cash collections to go up by 32%.

Explore More With Enter.Health!

These are just examples of how healthcare organizations can successfully implement RCM strategies. To explore more, visit Enter.Health and take advantage of our comprehensive suite of revenue cycle management tools. With our tools, you can develop effective strategies to improve financial performance, enhance data analytics capabilities, increase patient satisfaction, and maximize revenue.

Ready to get started? Contact us today and see how our team of experts can help you develop an RCM strategy that works for your organization!