Revenue Cycle Management Strategies: How to Improve Efficiency and Reduce Denials

Revenue cycle management plays a major role, and it is as important as quality patient care. Imagine RCM as the whole process of a patient bill, starting when the patient makes the appointment and going all the way up to when your practice gets the money.

An improper RCM system drains your practice and time, and resources. Inefficiency and denial of claims are the two biggest problems in this process.

The good news? With only a few of the strategies, you can make your entire RCM process much smoother and improve your cash flow, and ensure that those expensive denials are reduced by a significant amount. This blog provides the best practices to reduce claim denials and boost your revenue cycle.

1. Eliminating Denials Before They Occur

Patient Registration and Eligibility Confirmation

Real-Time Insurance Verification: Adopt a system that will automatically verify the eligibility of a patient and benefits due to the date of service. 

Why it is important: This raises questions such as lapsed coverage, a wrong policy number, or a service that must be asked permission before taking place. Avoiding it at the beginning will avoid refusal in the future.

Correct Data Intake: Educate your front-desk personnel to carefully check the patient demographics, such as name, date of birth, address, and insurance information, every time they visit the clinic.

Financial Clarity Upfront: Provide patient estimation tools that provide patients with a sense of what they will need to pay out of pocket (co-pays, deductibles). Talking about this early establishes expectations, thus benefiting not only your collections but also patient satisfaction.

Prior Authorization

One of the leading causes of hard denials- claims that can hardly be reversed are lack of prior authorization.

Dedicated Workflow: Determine a non-negotiable workflow of identifying all procedures that need pre-authorization. This has to be done once the service is booked.

Track Everything: Tracking software or a basic spreadsheet should be used to record the date the authorization was ordered, the point of contact of the payer, the reference number, and its status. Do not forget about an authorization request.

2. Accurate Documentation and Coding

Flawless Charge Capture

• Move away from manual charge sheets. Implement EHR and RCM systems that enable clinicians to bill at the point of care. This eliminates the possibility of missed charges and human error.

• Conduct regular internal audits to make sure that charges are being fully captured. Is the billing of all supplies done? Have all procedures been taken into account?

Medical Coding Necessity

• The coding rules keep evolving. Make continuous, compulsory training for your coding personnel to refresh their knowledge about new codes, the use of modifiers, and guidelines based on payers.

• Coders are fully dependent on the clinical documentation. Educate your providers to make sure that their notes are both comprehensive and readable, and that every service is being billed. The claim will be disapproved in case the code is not backed up in the documentation.

• Implement an automated claim scrubbing tool. This software checks the assertion against frequent mistakes, such as missing data or improper combinations of codes, and then it is sent to the payer as a quality control measure.

3. Reducing Denials and Maximizing Collections

Automating Claim Submission

• Send all claims electronically to a well-established clearinghouse, to speed, accuracy, and confirmation of receipt, which is far better than paper claims. 
• Install and vigorously enforce an internal, timely filing policy to make sure that claims are submitted long before payer restrictions, without automatic rejection and revenue loss. 
• Use your RCM software to automatically track the status of all claims so that you can monitor them proactively and reduce delays in processing.

Denial Management Strategy

• In case of denials, do not just apply fixes, but use analytics to determine the root cause, such as eligibility, coding, to put in place the upstream solutions that are permanent. 
• Implement a Rapid Response Team that focuses on payment follow-up, and be specialists in the payer appeal procedures and timeframes. 
• Appeal early,well-documented with good clinical support, to be able to overturn recoverable claims and recover lost revenue.

Increasing the Speed of Patient Collections

• Optimize collections by providing flexibility in payment, like portals, mobile payments and automated plans, so that patients can easily pay.
• Provide clear, patient-easy-to-understand billing statements so that there is less confusion between patients, thereby significantly cutting delays and payment frustrations.
• Implement proactive follow-up in the form of automated respectful reminders (text, email) to regulate the outstanding balances effectively and improve the collection rates.

Related: 7 Costly RCM Errors That Drain Your Hospital’s Revenue And How to Fix Them

4. Leverage RCM Technology and Automation

• Modern RCM programs are necessary; automate error-prone activities such as eligibility checks, submissions of claims, and posting of payments to enhance efficiency.
• Use the data analytics in the system to monitor the key KPIs, including Clean Claim Rate of over 95% and Denial Rate of less than 5%. 
• The evaluation of these metrics will enable you to identify certain process failures and concentrate on improvement as early as possible.

5. Ongoing Staff Training

• Offer cross-departmental education to make front-desk, clinical, and billing staff aware of how their operations can impact the financial chain of RCM as a whole.
• Establish regular compliance audits and mandatory training of employees to make sure that the employees are current with the payer policy, codifying updates and regulations that help prevent revenue loss and minimize audit risk.

Vozo Revenue Management Cycle Service for your Medical Practice

At Vozo, we understand your struggle in navigating through all the revenue cycle processes, such as regulations, medical coding, and reimbursements. 

That’s why we bring the best cutting-edge service to optimize your revenue cycle management from start to finish. Here’s how Vozo can help you transform your practice’s financial performance.

• Automated tools for error-free coding and faster reimbursements
• User-friendly billing to keep patients satisfied and payments flowing
• Robust data security and compliance protocols to protect your practice
• Detailed reporting and analytics for smarter business decisions
• Solutions that grow alongside your evolving needs

With Vozo RCM service, you can reduce the headaches associated with revenue cycle management and focus on what matters most is quality patient healthcare delivery.

“Partner with Vozo RCM Service and unlock the full potential of your healthcare practice and maximize its revenue”.