Practices utilize many tactics to increase revenue and strengthen their bottom line. Of those tactics, many involve patients, with the expectation that happy patients will become returning patients.
Practices may seek out the latest technology and inform patients about this new acquisition, hire new staff or provide staff training to improve patient flow and make care more convenient or renovate reception areas, exam rooms, or surgery suites to enhance the patient’s experience and comfort. However, although many patient-facing tactics attract opportunities for revenue growth, none of them are as important as revenue cycle management (RCM) for actually obtaining that revenue and strengthening the practice as a whole.
Why RCM Matters
RCM involves managing the administrative and clinical functions associated with claims processing, payment and revenue collection. It is a back-end service, rarely visible to patients except in instances of billing issues and therefore easily neglected by the patient-focused practice owners.
However, it is because of its behind-the-scenes vantage point that RCM is such a crucial tool for identifying weaknesses in the practice’s patient care and finance processes. When practices neglect RCM, these weaknesses can remain unresolved, leading to wasted time and resources, as well as lost revenue.
Are you neglecting your practice’s RCM? The following is a quick breakdown of three keys to RCM success: manpower, specialization, and data ownership.
The Task Should Not Outweigh the Tasked
Although the size of a practice can affect the size of its RCM department, there are usually only three or four individuals responsible for this enormous task. For those who keep an internal RCM team, even one person leaving this department is comparable to losing a quarter or more of your revenue collection knowledge. By the time you have gone through the process of searching for, interviewing, and hiring someone to replace them, you could be 30 to 45 days behind the workload and your cash flow will suffer.
RCM workload may include verifying patient insurance eligibility, submitting claims, receiving government and/or commercial insurance payments, billing patients for their share of service costs, posting payments and much more. A large task to lay on the shoulders of so few. If you are going to be overstaffed anywhere within your practice, it should be in RCM.
As for those outsourcing, the same concerns apply. Seeking out a more robust team that can more easily cope with potential employee turnover without slowing your revenue cycle could prevent unnecessary cashflow issues.
Trust in Specialized Skills
In addition to manpower, the right RCM team has the right expertise. When a patient needs eye surgery, they look for an eye surgeon, not a cardiothoracic surgeon. Similarly, ophthalmic RCM is a specialized skill set. When you need an RCM team for your ophthalmic practice, the best results come from those who understand ophthalmology.
For example, using more specific diagnosis codes increases the likelihood of receiving payment from the payor at the first claim submission. An ophthalmic-specialized coder is more likely to know the correct CPT/ICD-10 codes and modifiers for the most accurate, effective claim, limiting the need for resubmissions. When your RCM team knows your procedures, processes, and needs inside out, your revenue cycle runs more smoothly.
Protect Your Data
The final key applies to those who prefer to outsource their RCM. Business relationships come and go, making it risky to rely on your third party’s proprietary RCM software. If for whatever reason the relationship ends, how do you get your data back? It can make for an awkward, messy, and even costly transition. When looking for an RCM service provider, your practice will benefit from selecting one that will work within your existing software.
Prioritize Your RCM
Tactics designed to attract patients are essential, but they cannot replace a well-run revenue cycle management team. If a practice is not punctually billing and collecting for services rendered, not accurately coding and submitting claims, not effectively bridging the gap between the business and clinical sides of the practice, it will not matter how many happy patients walk through the door. The healthier your practice is financially and operationally, the better care and experience you can offer your patients.
About the authors: A managing principal of Medical Consulting Group (MCG), Robert McCarville, MPA, specializes in the field of health care management, administration, and strategy. Tonya LaRue, MBA, works alongside Rob as an MCG revenue cycle management and accounting consultant. For more information, visit medcgroup.com.