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Revenue Cycle Management: Maximizing Your Reimbursement (Part 1 of 2)

Revenue cycle management (RCM) is the process that handles claims processing, payment and revenue generation. If you think this means RCM lies within the billing office alone, you are probably leaving significant revenue on the table. RCM is the entire life of a patient account and the circulatory system of the practice itself.

The RCM cycle begins well before a patient ever sets foot in the door; training your staff, maximizing your schedule and creating a solid plan is essential to the success of your practice. While the billing office will have a significant function, each department plays a role in managing your revenue cycle. In Part 1 of the RCM series, we will explore the key areas to consider before the billing office receives a single claim.

Setting Up Your RCM Process

When developing your process, it is necessary to remember everyone contributes to the success of the plan.

Think of your RCM process not just as a way to capture money past due, but as a way to continually improve your revenue as a whole. Therefore, the process should have flexibility. It should also be scalable for future growth and routinely monitored in order to identify where changes need to be made.

Key areas include:

  • Internal elements
  • Customer service
  • Patient policies
  • Front desk team
  • Staff training

Internal Elements

Maximizing your revenue opportunity is an essential piece of the process. You need to have a strong marketing plan and a functioning website to educate potential patients about your services. This is the initial step towards driving patients to your practice.

Another piece of the process is to evaluate the providers’ current patient capacity. Consider the following:

  • Is there a way to increase their patients per hour?
  • Would they have access to more patient rooms or staffing if they shifted their schedules to different time slots?
  • Are you maximizing your space by having early morning or later evening hours? Weekend hours?

To cover some of these changes, you may find the need to hire staff/adjust staffing schedules. Evaluate the return on investment for adding more patients into the week vs. costs of additional staff. You might be surprised with the numbers and even the staff’s response to flex-hours.

Case study: A practice that was already successful performed a patient survey about improving the office. As it turned out, the office hours of 9 to 5 p.m. (with the exception of one evening) was incredibly difficult for patients. The practice evaluated the prospective opportunities vs. staffing costs and chose to implement a split schedule. Colleagues told them they were crazy and their staff would never go for it, but they went for it anyway, adjusting their schedules with a start time of 6 a.m. and an end point of 7:30 p.m. The patients loved it! In fact, there was a continuous three-week wait for appointments before 8 a.m. Then, they added a couple of Saturdays a month and the practice exploded. Providers and staff worked one of two shifts (6 a.m. to 1 p.m. or 1 p.m. to 7:30 p.m.). And guess what? They made it work. While this may be a drastic example, being flexible and openminded on how to increase your revenue opportunity is incredibly vital when developing your revenue plan.

Customer Service

Your staff is your internal marketing and sales department. The way in which they interact with patients at each touch point is imperative to assuring those patients will return and that they will tell friends about your practice. Unfriendly, disinterested staff can significantly damage the reputation of your practice, and thereby, your revenue opportunities. Taking time for customer service training with real-world examples and role-playing activities is a worthwhile investment.

Patient Policies

Incorporating patient policies into your practice sets up the expectations of the relationship. Generally, these policies are provided in writing with registration documents and patient signature required.

Examples of policy areas:

  • Late cancellations or no show’s
  • Billing cycle
  • Collection policies
  • Co-payments and co-insurances
  • Balance collections
  • Surgical or cosmetic deposits
  • Insurance changes and referrals
  • Payment plans

Through the patient policies, you can determine how to handle the most difficult part of RCM: communicating with patients about their financial responsibilities. With written documents, expectations are clear. Policies help patients understand their obligations and penalties. Furthermore, your staff has a signed document to refer to when enforcing those policies.

Front Desk Team

The front desk team is the first group of staff that starts the RCM process. This staff is responsible for assuring that patient schedules are maximized and correct information is given to your billing team.

Add the following responsibilities to their job descriptions (and train them on the importance of their role in the overall health of your practice):

  • Monitor automated patient reminders to reduce no-shows with calls. These calls should be generated 48 hours before the visit to have time to fill in the appointment slot with any reschedules or cancellations that come in
  • Maintain a cancellation list for patients who asked to be seen sooner than the schedule allowed
  • Review schedules two weeks/one week, three days out to assure patients have been placed in the correct slots and there are no gaps in the schedules
  • Build in emergency slots at the end of the day to capture patients that call during the day with an urgent issue. Adding them in at the start of the day typically means they will go unused, reducing revenue opportunities
  • Verify insurance eligibility for each patient electronically. This minimizes billing delays and denials while assuring correct co-payments are taken at the time of service
  • Collect co-payments, Medicare co-insurances and old balances at check in
  • Verify all demographics for each patient at each visit, including asking if the insurance plan has changed; this could be the difference in a “clean claim” going out or one that is denied

In addition, consider implementing a Credit Card on File program. This allows for automatic charges to patients’ credit cards for any balances incurred and significantly increases your cash flow. Most credit card processing companies offer a secured service with the credit card information stored in the cloud, not in your office. It also includes the ability to enter into automatic payment plans each month for larger balances.

Staff Training

Once you have established patient policies and front desk workflow, it is essential to train your staff not only on the RCM cycle, but also on the importance of their role in the process. Typically, front desk staff will be asked to enforce some of the policies and inquire about balances.

Your training program should include the following information:

  • The differences between co-payment, co-insurance and deductibles
  • How to review a patient’s statement and EOB
  • How to request various payments from patients in a positive manner (good role-playing exercise)
  • How to discuss patient policies (good role-playing exercise)
  • The staff member to escalate the financial conversation to, if a question can’t be answered or a solution can’t be found

Positive communication with your patients is critical, especially when discussing financial policies and responsibilities. Training and monitoring your staff’s handling of these discussions will make a major difference in the success of obtaining payment. The majority of your patients want to remain in good standing with your practice. Often, they are confused about their insurance plans and find it difficult to understand how they have financial obligations after paying significant insurance premiums each month. In training your staff to be sympathetic, educational and creative with payment options, you are more likely to have cooperation from your patients, continuing a long-standing relationship and increasing your revenue.