Revenue cycle management (RCM) is the process to track client revenue from registration through collection of accounts receivable balances. If you’re not managing RCM well on the front end, it can become difficult to catch up on the back end. So what steps can you take from the start?
To a large degree, the type of insurance a patient has will cue your schedulers to ask certain questions. When scheduling and registering new patients, it is critical that all collected information is accurate and complete, and that all insurance and coverage information is verified.
Tell all patients what to bring, including any copays. Prior to a patient’s visit, be sure to obtain any necessary authorizations, and request a referral for the visit or upcoming procedure. For first-time patients, you can be sure the insurance company will pay close attention to the patient’s chart. If you get all the details right the first time – from pre-registration through the first visit – you can avoid long delays.
This includes name identification, demographics and insurance information, all entered correctly. The lack of correct and complete insurance information is the number-one reason insurance companies deny claims. No matter how many times you see a patient, always verify that their insurance information has not changed.
Your front desk staff must clearly communicate your financial policies in writing. Make sure each patient signs an agreement of their understanding of your policy, which should include copays, unpaid balances, methods of payment and any financial agreements you offer. Requirements for prepayment should be made clear when scheduling the appointment, put in writing and included in signage at the registration window.
Be clear and proactive about the costs for specific services, as well as the coverage determinations and associated financial obligations for the patient, or whoever is financially responsible for them. Let patients know if you are out of their network.
Did you know: Almost 50% of patients said having clear information on expected out-of-pocket costs before receiving treatment impacts their decision to use a healthcare provider? (Source: MedData 2020)
To help increase collections, many healthcare practices are implementing financial policies that include collecting some of the balance the patient owes, based on an estimated cost of service. Doing so may help mitigate the collection challenges presented in the next chapter.
- Patient Registration
- Medical Billing and Collections
- Claims Submission and Management
- KPIs: Establishing Meaningful Metrics for Practice Improvement
You may download our new e-book by completing a brief form.
The healthcare accountants and advisors at Goldin Peiser & Peiser have decades of advising medical practices, hospitals and senior living facilities. They have helped their clients understand ways to maximize RCM by suggesting best practices and technology that can boost operational efficiencies and outcomes. Our Revenue Cycle Management Group specializes in driving system-wide efficiencies for medical offices, hospitals, surgical centers and long-term care facilities.
For more information, please contact Erick Cuter, CPA, or Alita Stratton, CPA, at (972) 818-5300.
Note: This content is accurate as of the date published above and is subject to change. Please seek professional advice before acting on any matter contained in this article.