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4 Ways to Optimize the Healthcare Revenue Cycle Management Process

Sep 16, 2022 3:48:35 PM / by Altruis

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Altruis shares 4 best practices for optimizing the healthcare revenue cycle management providers use to stay efficient and financially stable.

Revenue cycle management is one of the hottest topics in modern healthcare. The billing and reimbursement process is so complex that it’s difficult for healthcare practices to stay on top of it all and prevent things from falling through the cracks.

Why Is Revenue Cycle Management Important in Healthcare?

The revenue cycle is the process that occurs in a healthcare provider from the time a patient calls for treatment to the time the practice collects the money owed to it. This money comes from the patient's bank account or their health insurance provider. This process is complex and includes many moving parts. Without good revenue cycle management, a practice may struggle to stay in business.

What are your practice’s biggest challenges? As a healthcare billing, credentialing, reimbursement, and optimization partner, Altruis solves common challenges for healthcare providers. 

 

The Top 4 Ways to Improve Revenue Cycle Management Healthcare Processes: 

#1.  Set More Stringent Credentialing Rules

Providers at your practice must be properly credentialed to ensure that the practice can receive reimbursements from Medicaid, Medicare, and other payers. This is particularly relevant if your practice intends to maintain its status as a Federally Qualified Health Center (FQHC) with the U.S. Health Resources and Services Administration (HRSA).

It’s common for practices to have outdated and lax credentialing procedures that allow too many mistakes to happen. Every missing piece of information or erroneous credential is a potentially denied reimbursement.

A healthcare revenue cycle management service can help your practice address and resolve credentialing issues. For more information about credentialing, see the Coalition for Affordable Quality Healthcare (CAQH) database that sets forth uniform credentialing protocols. 

 

#2.  Refine All Medical Coding Procedures

Did you know that there are now more than 10,000 individual medical codes actively in use in the U.S. healthcare system? There are also more than 69,000 diagnostic and disease codes that are possible to use during patient interactions and treatment. 

The number and variety of codes will continue growing in the coming decades. There’s so much to coding that most healthcare practices have hired medical coding specialists or hire coding services to manage it.

Medical coding is a challenging part of running a medical practice because incorrect codes lead to reimbursement denials. Data like medical necessity and medical severity are reflected in these codes, which is why insurers and government agencies are so strict about precision in coding.

Proper coding takes more than just efficient data entry. It takes problem-solving and fast issue resolution, plus detailed tracking. Coding is part of your provider’s overall financial risk management.

Streamline your medical coding by eliminating duplication, preventing the repetition of tasks, and avoiding keystroke errors. Digital coding is one of the best ways to preserve the integrity of your coding data, plus it’s easy to transmit to the proper places for reimbursement.

#3. Leverage Your Practice’s KPIs

Key performance indicators (KPIs) are often misunderstood or ignored in the medical community because they’re more commonly associated with the business world. They’re essential indicators of business success and health and reveal the overall performance of your practice in a financial sense.

Take a close look at percentage-based KPIs like the percentage of evaluation and management services you’re billing in each category. Compare new and established visits to see whether too much time is being spent in a certain category at the expense of others.

Are you tracking these medical practice KPIs?

  • New patient numbers
  • Patient-to-staff ratio
  • Cost per encounter
  • Days claims spent in accounts receivable (AR Days)
  • % of AR over 90 days
  • Missed appointments/no-shows
  • Attrition/lost patients to other practices
  • Claims denial rate
  • Top denial reasons
  • Total practice revenue

Examine outliers and compare your practice to national statistics. KPIs often reveal information that could allow you to adjust and optimize your practice performance.  This is especially powerful when trended over time to highlight changes from issues or improvements made.

#4. Claim Retroactive Medicaid Through RetroPayTM

Long after their first visits, many uninsured patients become eligible for care reimbursement through programs like Medicaid and Medicare. However, your practice may have already billed them individually or might have even moved them into collections status for nonpayment.

These patients’ coverage can often be retroactively claimed for uncompensated care through RetroPay.TM This service helps you maximize your revenue and is mostly invisible to your patients, who aren’t responsible for covering the amount due. It’s claimed by the insurer/program that provides coverage, so it’s a win-win for the patient and the provider.

Plus, with Altruis as your healthcare revenue cycle management partner, there is continual year-round monitoring of your reimbursements for retroactive eligibility. Every possible dollar is identified and collected.

For example, one Altruis patient received an additional $500,000, which more than doubled their Medicaid reimbursement. This patient continues to take in $100,000 per month in increased revenue by using the service.

How to Start Optimizing your Healthcare Revenue Cycle Management Process

As you can see, Altruis works as much more than just a billing or credentialing platform. We’re your full-service healthcare revenue cycle management partner and friend in the business of running a medical practice. We’d love to show you how we accelerate reimbursements and make custom recommendations to maximize your financial success.

 

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Topics: Revenue Cycle Management

Altruis

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