Revenue Cycle Management Blog | GroupOne Health Source

Improving Your Revenue Cycle Management in 2016

Written by Kaitlyn Houseman | December 22, 2015
A new year on the calendar offers something of the "look and feel" of a clean slate, but any medical practice manager will tell you that things aren't going to get simpler or easier in 2016. The entire revenue cycle management process is undergoing a period of rapid change due to the Affordable Care Act, the rise of value-based reimbursement, and the proliferation of high-deductible healthcare plans.

Naturally, you want your practice to have the most successful year in the books in 2016, and often this requires being critical not only of your RCM performance but your own performance. Improving your revenue cycle operations in 2016 will take some investigating into the hard questions you've been avoiding and prioritization on your part to find solutions. Here are some ideas on improving your practice's revenue cycle management in the new year.

Evaluation of Existing Strengths and Weaknesses

It's harder to get where you're going if you don't know where you are. Metrics tell part of the story, but some information may only come to light by talking to employees that are handling different parts of the revenue cycle. Here are a few questions to ask to get started:

  • What happened to the claim rejection and denial rates in 2015?
  • What percentage of patients were uninsured?
  • What was the net collection rate on average?
  • What were your biggest collections issues in 2015?

Also, what have you been doing well? It's important to define what created a positive change and how you achieved that change so you can be successful the next time around.

Identification of Metrics That Make a Difference

Some metrics will always matter in terms of the effectiveness of revenue cycle management. But you need to identify metrics that apply especially well to your practice so you can monitor them in the coming year. Maybe cash flow slowed significantly when you implemented ICD-10. Is it recovering? What is causing the delay in cash flow and what can you do today to fix it?

Or perhaps once your clean claims rate reaches a certain threshold, revenues tend to be stable and easier to predict. Understand all revenue cycle management metrics, and determine which ones have a disproportionate effect so you can watch them closely.

Engaging Effectively With High-Deductible and Self-Pay Patients

Statistics show that for medical practices self-pay collections are a source of rising concern, increasing costs, staff time, and lost revenue. Increased patient financial responsibility is one of the top issues medical practices will face in 2016. There has been a tremendous increase in the number of consumers who have high-deductible healthcare plans, both from the exchanges and from employers. It's a big shift, and it's happening quickly.

  • Evaluate your practice's financial & self pay policy and see if it needs to be changed in light of the increased responsibility patients have for paying for healthcare. Handing out copies of the policy on a patient's first 2016 visit to your practice is a small step to overcoming the challenges of self pay collections. 
  • Use automated phone calls and emails to alert patients of their balances.
  • Offer an online payment portal to your patients. If it has the ability to offer payment plans then that is even better!
  • Work with your front office staff to create an effective self-pay workflow that includes checking eligibility, collecting copays and previous balances, obtaining authorizations, and collecting pre-payments for procedures. The more money you can collect upfront the more time you will save chasing down the patient and the more money you will bring in for the practice.

Avoiding a Disconnect Between Front End and Back End Functions

Revenue cycle management tends to be back-end heavy, but perhaps 2016 is the time to change that. How your patient-facing personnel handle their tasks can help or hurt revenue cycle management. Communication between back and front office functions is also important for long-term improvement. If a claim has to be resubmitted because your scheduler didn't check on pre-authorization requirements, the incident is not only important to the person responsible for resubmitting claims, but also for the scheduler, whose actions may have more effect than they realize.

Ask if Your RCM Process Is Up to Today and Tomorrow's Challenges

Many legacy revenue cycle management operations are optimized for commercial and government billing, but that is less relevant in an age where patients are paying a much bigger share of their bill. With high-deductible plans increasingly prevalent, revenue cycle management processes and tools must take self-pay patients into account. 

97% of business managers confirm that an innovative seamless RCM/EHR/PM system would greatly improve productivity and profitability. If your RCM process is not seamless with your EHR system then you need to consider how this is impacting your organization. Consider other solutions to see what is out there. If you find that what you are doing today is working and you'd rather stick with it then good. If it isn't working and you find a better solution then make it happen. Reimbursement for medical services isn't getting any easier.

Consumers bear more of the responsibility of paying for their healthcare needs, and at the same time, they're more informed than they used to be about medical costs. A financially healthy 2016 requires that your practice understand its existing strengths and weaknesses in terms of revenue cycle management, take steps to collect more at the front end of the revenue cycle, and ensure your practice's software systems are up to the increased demands on revenue collection.