As the owner of a dental or medical practice, your main focus is on providing your patients with the best care possible. However, in order to keep your practice running and the doors open, it’s important to have excellent revenue cycle management.
Revenue cycle management (RCM) refers to managing and collecting payments from patients for services rendered. It’s a process that starts when patients pre-register and make an appointment at your facility. It doesn’t end until you submit a claim to the patient, and it’s paid by either them or their insurance company.
While this sounds fairly straightforward, revenue cycle management is a lengthy and complicated process and may be beyond your scope of knowledge. Whether you handle revenue cycle management on your own or have a team that assists you, it’s important to know if the process is working well. This article will explain the five signs you should use when making this determination.
Keep Accounts Receivable Within Good Guidelines
Accounts receivable (A/R) in healthcare refers to the invoices and claims from patients and insurance companies accrued at your dental or medical practice. You can tell if your RCM team is doing a good job by whether or not they can keep the accounts receivable department within good guidelines.
“Good guidelines” refers to the number of days between when you invoice for a service and when it’s paid, in other words, your A/R. A/R will vary depending on the type of practice you have and the insurance carriers you accept. In general, though, any outstanding claims that remain in accounts receivable for longer than 90 days are not a good sign. However, because accounts receivable guidelines will vary from practice to practice, you should work with your PBM consultant to set up an acceptable timeline. Collecting as much as possible from the patients as they are seen reduces your headaches down the road.
Address Claims Denials Promptly
From a patient’s perspective; few things are more frustrating than when their insurance company denies a claim. However, in addition to being inconvenient for patients, denied claims are also bad for business on your end. This is especially true when they fall by the wayside and don’t get addressed for weeks or months on end.
If an insurance claim is denied by the carrier, the medical or dental practice needs to make necessary corrections, follow up with the carrier, and resubmit the claim.
There’s also a good chance that patients will have questions for your RCM or billing team. It is the responsibility of the RCM team to assist patients when they call with questions and address them accordingly.
Review and Negotiate Your Fee Schedule and Insurance Claims Annually
It’s important that your RCM team keeps a close eye on your dental fee schedule or medical fee schedule and insurance claims. For maximum efficiency and revenue, they should review and negotiate these aspects annually to ensure you’re getting the best rates and maximizing your income.
Additionally, here are three things your RCM team should always do:
- Bill for all costs that relate to delivering and providing patient care. Sometimes certain costs get missed. Make sure every cost to deliver care is included.
- Be open to submitting to insurance more than your true costs. If you bill for $100 but the carrier would pay $125, you’ll never find that out.
- As you assemble your costs and develop your billing strategy, focus on your top 20 codes first. These are the codes you bill most often and likely represent either the biggest proportion of your total revenue, the biggest amount of daily activity, or both. It’s important that all applicable costs are included in the insurance claim to avoid potential slowdowns in the claims process.
Collecting at the Time of Service
Even though online payments are all the rage these days, they can actually hurt RCM rather than help it. This is especially true for deductibles and co-pays that should be received by your team upfront after the patient’s visit.
As such, it’s important that collecting these fees happens at the time of service and not afterward with a mail-in check or online. In addition to ensuring that you receive payment on time and in full, immediate payment collection in your office also saves money on postage and the necessary labor.
Finally, it’s imperative that your RCM team has excellent communication skills. Fast and effective communication will speed up claims resolution, payment collection, accounts receivable, and every other aspect of your practice. In addition to excellent communication within your RCM team, it’s important to communicate well with:
- Insurance companies
- Clinicians within the practice
- Your accountant
- You, the practice owner.
Prompt and efficient communication is the best way to maximize revenue and keep your patients happy. It will allow your team to spot potential problems before they actually happen and give them a chance to avoid them altogether.
What If My Revenue Cycle Management Team Needs Help?
If you have questions about revenue cycle management or if you have concerns that your practice needs a “check up,” please contact us at Professional Business Management. We offer revenue cycle management “check-ups” to assess your needs and to assess your current system. If you are interested in hearing more about how we can help, please contact us.