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Revenue Cycle Management – Getting Paid on Time

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An effective Revenue Cycle Management helps practices to increase efficiency and revenues. It also ensures to cut cost and reduce denials considerably. Revenue Cycle Management is not about just one activity, it is all about managing the entire process from start to finish. In the healthcare setting Revenue Cycle Management begins even prior to a patient’s visit to the facility.

Pre-verification is the first step in Revenue Cycle Management. All the patients scheduled to visit the provider are verified for eligibility and benefits with their insurance. All authorization and referral requirements are clearly understood and documented. Co-pay, Deductibles and out of pocket expenses are also documented. First step to effective Revenue Cycle Management begins with collecting the patient liabilities immediately during the visit.

Accurate coding not only reduces compliance risk but also helps to reduce denials and speeds up the revenue cycle. To avoid up coding, down coding and incorrect coding, a certified professional needs to ensure that all the diagnosis and procedures are coded accurately on time. Incorrect coding results in delayed reimbursement with inclusive and exclusive denials. It is also very important to use the right modifiers and link them to appropriate procedure codes.

Many denials are usually generated from non submission of clean claims. This issue arises due to inaccurate patient data capture during the patient registration process. A good standard registration process eliminates and reduces many denials. This absolutely improves cash flow for any healthcare practice. Front desk staffs at the healthcare facilities need to ensure that all the patients’ and their insurance information are accurately documented.

An effective standard operating procedure ensures that all the patient claims are submitted within 24-48 hours. This helps to shorten and speed up the claims turnaround time. Submitting clean claims electronically within 48 hours from the time of service, positively improves collections and ensures healthy cash flow for the practices. For effective Revenue Cycle Management we need to use a combination of skilled certified resources and advanced technologies.

An effective follow-up ensures that the providers are paid on time for the services provided. It is very important for any healthcare organization to have control on short and long term receivables. A timely follow-up ensures claims resolution on time, resulting in payment. Insurance companies have their own claims filing and appeals time limits. It is important to understand the insurance claims adjudication process, rules and regulations. The primary objective of the Revenue Cycle Management is to maximum revenues, improve cash flow and reduce bad debts.

There are many ways to manage your account receivables. A systematic approach to follow up on outstanding claims is a good way to start. Review and list the most common denials received for your practice. Get to the bottom of each denial and understand why it is getting denied and get to the root of the problem. Fix the issue and address it across all patients affected by the same denial. Set a robust process to resolve all issues quickly. Regular follow-up and random auditing for accuracy definitely helps in good Revenue Cycle Management.