Question

Revenue Cycle Management
Data is collected at each step of the revenue cycle, and an error or lack of action at any step in the cycle may result in delayed or lost revenue.

Discuss three steps in the revenue cycle, explaining what action occurs; provide an example for each step.

Describe a negative result, for each of your selected three steps, which may occur if the action is completed incorrectly or not at all.

Select one impact, from those you identified, and apply a policy which notes the process to be taken to prevent or minimize future occurrences of the noted negative event.

Answer 1

The definition of Revenue Cycle Management(RCM) in healthcare is the process of managing your office’s claims processing, payment and revenue generation. In order to efficiently manage the patient revenue cycle of your office, you’ll need a medical billing softwareor practice management software that allows you to effectively keep track of the claims process. The entire healthcare revenue cycle process includes everything from determining patient eligibility, collecting their co-pay, coding claims correctly, tracking claims, collecting payments and following up on denied claims.

Problems with the Health Care Revenue Cycle

If your office is struggling to stay ahead for patient billing, take a look below to see if you’re encountering the problems below.

Frustrated with your office’s medical billing? Consider finding a RCM partner today.

–          Staff has not been properly trained or educated. Optimizing your 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. Coding errors, incorrect data entry (insurance information, patient demographics, etc) or simply a failure to understand how their job affects the revenue of the office can result in your staff making costly mistakes.

–          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 physicians and office managers must remain open and weekly meetings should occur to review the financial reports including accounts receivables, collections and revenue.

–          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.

Why Revenue Cycle Management Is Important

Aside from preventing the problems above, did you know that CMS rejects nearly 26% of all claims and up to 40% of those claims are never resubmitted? This can result in lost revenue of up to 10% per physician. However, with the proper revenue cycle processes and workflows in place, your office can increase payments while decreasing bad debt write-offs. (In other words, your practice will stay in business!). How? You may need to invest in an office consultant or medical billing company that specializes in Revenue Cycle Management. They can help you address problems in training, communication and workflow.

Finding Revenue Cycle Management Solutions

For some practices, the responsibilities of the revenue cycle can become overwhelming and conflict with other office duties (managing employees, keeping up with government programs like MACRA and MIPS or other administrative tasks). However, that shouldn’t keep your office from becoming financially efficient. If you interested in optimizing your revenue cycle, consider a Revenue Cycle Management companythat will partner with you to get the most out of your office’s revenue cycle. Don’t wait — every day without the correct processes in place can result in decreased revenue for your office.