Historically, there was a belief in healthcare that revenue cycle management (RCM) was only a job for the back office. But today, medical practices are well-aware all staff members are critical to the revenue cycle. This responsibility extends through every aspect of a practice, from the front office to back office with the clinical staff in between.
The front office, for example, plays a role in generating revenue, because they can optimize scheduling and collect patient and insurance information, as well as co-pays upfront. The clinical staff can ensure that revenue is captured through proper documenting and coding, while the back office focuses on collecting revenue through billing functions.
Today, all staff members contribute to a practice’s bottom line.
RCM Starts in the Front Office
The stewardship of RCM starts long before the first visit, with the front office staff collecting patient and insurance information and confirming eligibility before the appointment. During this process, it’s also best practice to ask about a patient’s primary and secondary coverage, since practices tend to leave money on the table by filing only primary insurance claims.
The front office is also tasked with appointment reminders – either through mHealth, social media or automated reminders. Since practices lose revenue when patients don’t show up – and miss the opportunity to make up that revenue or generate more if they can’t fill the opening – engaging with patients via these engagement solutions is crucial.
As a final step in the process, the front office should collect co-pays and be trained to discuss finances with patients before the visit, particularly since many now have high deductible health plans (HDHPs).
The Clinician’s Role in RCM Billing Services
Clinicians today juggle many tasks outside of treating patients. This includes focusing on finances as well. ICD-10 coding rules and value-based reimbursement requirements make it necessary for clinicians to be cognizant of documentation practices so they can capture all details of the care they provide.
It’s important that clinicians are educated and follow the guidance for complying with payer documentation requirements. Not doing so can result in denied claims, which means the back office will be bogged down in fighting denials and delayed payments. Deep understanding of coding enables clinicians to bill at the highest clinically appropriate level for each patient visit, helping the practice generate more revenue per patient.
How to Improve the Revenue Cycle in Healthcare
Yes, the back office still remains the central point for billing and collections, as well as interfacing with payers to ensure claims are accepted and paid. But having the front office manage information collection and coverage verification, as well as initial payment collections, takes many of the previously time-consuming tasks off the back office. This frees up the back office to manage appeals, send collection letters, work with patients on payment plans, and do other follow-ups necessary for the practice to be compensated for services provided.
To help streamline processes and improve the revenue cycle process in your practice, back-office staff can leverage clearinghouses as an interface for claims management. These clearinghouses connect the practice management system with government and commercial payers to facilitate claims processing. They make it easier for practices to view, edit, correct and submit claims, improving acceptance rates, and maintaining revenue flow.
Here are some tips to help your staff effectively manage RCM across the board:
– Gather patient insurance and contact information before patients arrive for an appointment. Staff should be prepared to collect complete and current insurance and contact information when a patient makes an appointment. Information can be taken over the phone, entered by patients via an online portal or securely emailed.
– Verify insurance eligibility and identify any amounts due from patients prior to patient visits. Providers should confirm patient coverage with payers and clarify payer rules.
– Collect copays and other patient-responsible balances at the front desk when the patient checks in. The best time to collect payment from patients is when you have the opportunity to do so face to face. Establish clear policies and enforce them routinely. Make a practice to discuss payments either before appointments begin, or as patients check out.
– Offer multiple payment methods. The easier it is to make payments, the more likely you’ll get paid. Offer flexible options, including cash, check, credit/debit card or flexible spending accounts.
– Offer payment plans and track them. For procedures that extend beyond the health savings account, or for uninsured patients, establish plans that let patients pay over time. And train staff on how to communicate these options to patients effectively and track them properly.
– Make follow-up part of the routine. Perseverance is key to maximizing collections for patients who don’t make timely payments. Develop a routine, proactive timeline for initiating phone contact, and create a script for staff to follow as they reach out to those who have outstanding balances.
About the Marvin Luz
At Greenway Health, a leading health information technology and services provider, Marvin Luz serves as senior director, Greenway Revenue Services. With more than 13 years of experience in the ambulatory EHR and practice management market, he oversees the daily billing operations of revenue services for customers, ensuring compliance with divisional established policies and protocols, adherence to government and insurance payer policies, and assurance of customer conflict resolution. In addition to his daily responsibilities, he also leads the Patient Call Center and Patient Accounts Receivable teams at Greenway.