Why You Need to Focus on These Areas for Better Revenue Cycle Management
Businesses strive to earn more revenues in the hopes of translating these into profits with the right cost control measures. However, what good is earning revenues if it is not predictable? In healthcare, this is when the concept of revenue cycle management comes into play. Revenue cycle management, or what is commonly referred to as RCM, is the process by which healthcare providers track their revenues starting from the patient’s initial appointment up until the final payment for the services administered. It is basically just the patient’s life cycle but from a financial point of view.
For home health and hospice agencies like yours to have a sustainable business, you would need to repeatedly get to the last step of RCM, and that is payment receipt. As the process is a cycle with interlinked and sequential steps, you must evaluate and scrutinize every phase for vulnerabilities. To help you, we have listed the common financially vulnerable areas of the process.
Intake, Eligibility, and Admission
This is the first phase in the process and probably the most crucial one. This is when you get the patients’ data such as their personal information, social security numbers, doctor’s orders, insurance coverages, and eligibility data and benefits, among others. It is of utmost importance that all these data are accurate and complete as errors can lead to delays in-patient care, or worse, claim denials. The improper conduct of eligibility checks may also result in the provision of services which may later be found out to not be covered by insurance and would, therefore, not be eligible for reimbursement. As this phase requires extensive administrative work that may leave a lot of room for errors if done manually, most providers adopt an Electronic Medical Record (EMR) system to help them out. The EMR not only automates and makes the process more efficient but also makes your data gathering and reporting more accurate and compliant.
Billing and Claims Submissions
An efficient billing process can make the difference between getting your claims approved or denied. An electronic system that checks the quality of your billings prior to submission and allows claims to be directly submitted to the insurer’s portal or payment gateway will not only lessen the administrative work done by your billing staff but will also ensure that you meet deadlines and get timely reimbursements. It is also advisable to make follow-ups every two weeks on the claims you already submitted to keep track of their progress.
Unless the internal processes are perfected in your agency which is a difficult thing to achieve, it is inevitable that you receive claim denials. However, a denial is not the end of the line yet. It can still be managed through regular communications with insurers to identify the reason why the claim was denied. It is wise to prioritize high value or easily corrected ones since your agency will get the most out of them. You also have to make sure that you submit corrected claims as soon as possible so that you can avoid losing the payment altogether.
An optimized and predictable revenue cycle management is the core of your agency’s finances. Without it, home health agencies and hospices might not be able to sustain their financial stability, thus getting in the way of quality patient care delivery. Data Soft Logic, as an intelligent care partner, can help you optimize your revenue cycle. With our software solutions designed for home health and hospice, you can streamline your workflow, ensure proper documentation for claims submissions, and expedite your billing cycle. Schedule a demo with us now to learn the many ways we can help you maximize your revenues and profits.
