In addition to providing quality healthcare, most hospitals also aim to increase their revenues. However, a fall in the volume of patient visits, reduction in reimbursement rates, and increasing requirements for regulatory compliance can impact revenues and create problems. Failure to adhere to medical necessity requirements at the pre-registration phase is the chief cause of denials and underpayment. It is a good idea, therefore, to outsource RCM services to an experienced professional team whose sole focus is to bring in greater revenues for your practice.
Here are three steps that can be taken by RCM service providers to control revenue functions:
Patient Access and Utilization
Patient satisfaction depends to a great extent on their perception of the healthcare provider and it begins at the first touchpoint. Patient dissatisfaction can be triggered by improper intake processing and appointment scheduling, problems in verifying the insurance coverage, and so on. This also causes delays in billing, leads to numerous denials, and eventually necessitates reworking and resubmitting claims. All of this leads to a loss in revenue. The majority of the information required to generate and submit a claim to the insurers is collected at the first stage of the revenue cycle, and it’s also here that the greatest number of mistakes are made. RCM services should focus on improving this stage and on these critical processes and put safeguards in place to make sure that precise patient information is collected before the patient visit. This will lead to timely and accurate billing and payment collection.
Capturing Charges and Billing
Precise charge collection is crucial for the financial success of any healthcare provider. Unfortunately, many providers do not bother to supervise or validate charge veracity and relegate this task to lower administrative employees. Improper charge capture is risky and can impact your finances negatively. When healthcare providers don’t make it a priority, it affects their bottom line. To take care of this problem it is important that the whole process of charge capture is improved with steps like chart audits that check the precision and completeness of the charge process as well as improve the process to prevent leakage. Managing billings, collecting payments, and handling denials are expensive processes for any healthcare provider. It is vital to put systems in place to ensure that collections occur correctly and in time and to also handle denials efficiently. All these steps will help to minimize the cost of these procedures and bring in more revenue.
Reduce Denials and Underpayments
Commercial payers like Medicaid, Medicare, and others have tightened their conditions for reimbursements and more audit recovery programs have been introduced. So as a healthcare provider, if you fail to comply with these regulations, your organization’s finances could be severely impacted. The first step in the compliance process with payer requirements is when ordering takes place in the doctor’s office. Automated systems can be configured to provide alerts to doctors whenever Medical Necessity requirements have changed. This facilitates altering patient orders to remain clinically appropriate and in conformance with specific requirements of payers. By attaching relevant documents, denials and recovery finding requests can be reduced or even eliminated, which can help prevent revenue loss.
There are 3 critical ways in which health care providers can control their revenue function and bring greater cash flow into their business. To begin with, healthcare providers can improve their patient intake and appointment scheduling processes to ensure that all the information they collect to verify insurance coverage and the like are accurate and complete. This will go a long way in preventing claims denials and lead to more effective billing and payment collection. Another way to improve the revenue function is by implementing chart audits to check the completeness and precision of the charge process. The last way to support the revenue function of a service provider is to comply with regulations and the specific requirements of the payers involved. This will reduce recovery finding requests and denials so that revenue loss is further mitigated.