How to Optimize Your Healthcare Revenue Cycle Performance?

Have you ever wondered why even with all the efforts, revenue cycle management in practices continues to remain elusive? One of the primary reasons is the continuous shift in rules and reforms that are a little complex to adapt to at first. But as soon as you are good at it, Bamm! There is a new reform that needs to be worked around.  

When it comes to revenue cycle management, the healthcare sector is seeking assistance from digital platforms. That helps payers, providers, and consumers, engage and connect better, strengthening the revenue cycle management. But there are still several areas that need a bit more focus.

Revenue cycle managers need to concentrate on crucial points to help ensure the reimbursement stays optimum.

1. Minimize denials

As per the data, claim denials cost each provider $5 million annually. That is a lot of money at stake. There is no double that minimizing these denials can help bring in additional cash flow. Practices can use analytical tools to integrate the data from various sources. Doing that will help determine the root cause of the denials. Finally, practices can use the captured information to develop an efficient denial prevention plan.

2. Organize and manage clinical documentation

Clinical documentation is more than just a necessary component of the healthcare system because it directly affects the revenue cycle. DRG assignments and medical coding impact medical billing, and if done wrong, they may lead to denied claims or inequitable compensation. It’s time to confront the facts: how good is your record-keeping?

Close cooperation between medical coders, clinicians, and CDI specialists (CDIS) is necessary for an efficient CDI (Clinical Documentation Improvement) program. The CDI specialist reviews all clinical documentation and consults with doctors to identify potentially overlooked clinical indicators or documents missing in specificity. If these issues are discovered early, it may lead to more accurate medical coding, excellent care, Case Mix Index (CMI) levels, decent quality reporting, and appropriate reimbursement.

3. Increase collections

Since patients are responsible for increasing healthcare spending, self-pay accounts are the primary source of bad debt for hospitals and health systems. The healthcare sector incurs annual losses of more than $55 billion due to bad debt. Health organizations require strategy-driven patient collection procedures or a reliable propensity-to-pay predictive model to prevent bad debt.

4. Automate payments 

The ability of providers to document and submit claims is changing due to automated charge capture. A charge can be documented and captured all at once with integrated technology, reducing yet another stage in the revenue cycle management process & increasing the overall validity of your claims. In addition, this instrument has the most recent and widely used medical codes that pertain to your services, which lowers the likelihood of rejection or denial and increases the likelihood of receiving payments on schedule and in full.

5. Outsource RCM Services

One of the most nuanced decisions a provider can make to enhance Revenue Cycle Management is to partner with an RCM services vendor. You and your vendor can collaborate to determine the parts of each phase that are causing denials. As a result, you can increase patient payments and increase your revenue. Trained billing professionals and a practice management system within your clinic can help you handle complex billing and coding issues. It enables you to submit more accurate claims and maximize your ROI.

How can Capline Healthcare Management help?

When it comes to successful and efficient RCM, a few steps in the correct direction can go a long way. First, a well-established and efficient RCM procedure ensures smooth revenue creation and the success of your company’s finances. Additionally, working with the top professionals in the field can help you save time, effort, and money without sacrificing the standard of clinic administration or patient care.

It is time to get on a call with Capline Healthcare Management if you want to take advantage of cutting-edge RCM solutions and enjoy the advantages of a productive revenue cycle.