Revenue Cycle Management - It Does Not Have To Be So Tough !

RCM stands for a complex set of activities that are needed to be done by healthcare providers to get paid for the work they do. It is an area that needs a lot of attention especially since payments involve multiple parties like patients, insurance companies, etc. In this article, we give you five tips to improve your processes so that you generate maximum revenue.

The job of helping people and saving lives is what makes most physicians tick. However, even though patient-care should always be numero uno on the list of priorities for any healthcare provider, it is also vital to have a good handle on revenue generation methods to ensure that the financial health of your enterprise is not taking a hit. A firm grip on the various facets of RCM is the need of the hour if you want to run a sustainable practice. The nuances of the processes add to the complexity of the revenue lifecycle associated with a healthcare venture of any size [1].

There are several challenges faced by healthcare providers when it comes to administering each piece of the revenue cycle. A Management Service Organization or an MSO can help overcome these challenges by taking over the execution of every step of the revenue cycle including billing and collections [2]. Here are some ways in which an external MSO can help in improving the cash flow for a healthcare facility:

1. Insurance Verification – Insurance eligibility is a crucial piece of information that should be collected as part of the initial patient registration process. By doing so, you can ascertain that the patient is insured, whether you are an in-network or out-of-network physician for the patient, if there are any co-payments to be collected, etc. An MSO can assist you in streamlining a process for the initial registration that includes insurance verification.

2. Submitting Claims on A Regular Basis – Many practices have a haphazard way of submitting claims which leads to lost claims and as a result a loss of revenue. By setting up a periodic schedule like a biweekly or tri-weekly one, you can ensure that your claims are submitted correctly. An MSO helps you structure your claims management and submission process.

3. Follow-up on Rejected Claims – Insurance companies often reject claims due to minor errors in the claims submitted. It is therefore essential to keep an eye on such rejected, or underpaid insurance claims to understand the reason behind the rejection and resubmit the claims correctly and in time to avoid revenue loss. An MSO takes charge of this task and guarantees that the claims that have been sent back by the insurance companies are addressed appropriately and on time.

4.       Monthly Reporting System – A monthly reporting process that analyzes the various aspects of revenue cycle management can help in figuring out the gaps that need to be plugged to avoid mismanagement and errors. A regular reporting procedure will also give you a chance to check for areas where compliance issues, manual errors, data security breaches, etc. are likely to occur.  An MSO can put a reporting process in place for you as well as analyze the data and draw inferences that can be used to improve operations.

5.       Take note of Regulatory Modifications – The healthcare sector has experienced a lot of policy upheaval in the past five years. From the Affordable Care Act (ACA) to ICD-10 roll-out to the annulment of ACA – policymakers have made sudden changes. It is necessary to be current with what changes are happening and how they will affect you and your practice. By keeping up to date with the latest events, you can avoid interruptions in your revenue cycle. An MSO helps you keep track of and understand policy changes.

Mirra Healthcare is a Management Service Organization that offers Revenue Cycle Management services to healthcare facilities of all sizes. Mirra employs competent professionals who are knowledgeable in the field of healthcare management and understand the intricacies of each component of the revenue cycle. The team at Mirra recognizes the healthcare landscape and its continually changing regulations. By outsourcing the management of your revenue cycle to Mirra, you can focus on patient care while a dedicated team of qualified personnel maximizes the revenue generated by your organization.

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