What is revenue cycle management? Why is it important for an independent practice, especially as healthcare is moving away from the fee-for-service model and toward value-based care? Here are some healthcare revenue cycle management tips for your new practice.

Your practice revenue cycle begins with a patient’s initial call to make an appointment and runs through to the point where that patient pays all outstanding balances. The cycle encompasses all aspects of the patient’s account with your practice. Revenue cycle management for healthcare providers includes all the functions that contribute to patient service revenue.

How can an effective revenue cycle management help your new practice? Benefits can include:

• Significant cost reductions that are typically associated with automating and digitizing your new practice’s billing, claims, and reimbursement functions. Streamlined administrative processes can save your practice a substantial amount of money.
• Improved revenue collection, both from patients and from third-party payers.
• Revenue increases as a result of quicker turnaround of invoices and minimized claim denials.

See how Elation’s RCM services streamline billing for your primary care practice.

When you are searching for the right revenue cycle management system for your new practice, keep in mind a few tips about what you will need for effective end-to-end management of the patient-revenue process, such as the ability for your staff to:

• Collect and confirm that all patient data, including insurance and demographic information, is accurate and current at each visit.
• Verify insurance information, especially specific coverage, for the recommended course of treatment without waiting on phone calls or faxes to be confirmed.
• Collect co-pays at the time of the visit, based on that insurance information.
• Code and submit claims efficiently to third-party payers.
• Address insurance denials, appealing denials, and billing the patient in a timely manner and accurately.
• Produce customized reporting and analysis.

As healthcare providers move toward value-based reimbursement and away from the fee-for-service model, the right revenue cycle management solution will become even more important for the financial sustainability of the practice. With a goal of improved patient outcomes, you will need to optimize your healthcare revenue cycle management operations by including technological capabilities that enable you to collect data and drive analytics.

In regard to optimizing the use of revenue cycle management, healthcare providers should also ensure that the patient needs are taken into account. If the tool is not managed well, it could result in a suboptimal experience for your patient, which could impact the potential for your new practice’s success as well.

Ensuring that the patient is part of the process, in particular that there is no surprise billing, is critical for reducing costs and increasing revenue. The Brookings Institution has noted that surprise billing is associated with higher healthcare costs, so informing the patient of cost estimates and claimable expenses is important for you and your patients. When a patient is not aware of the costs that they may be liable for, it can result in an unhappy patient who is less willing to settle their accounts.