Altruis Blog

Revenue Cycle Optimization: Best Practices and Strategies

Dec 13, 2023 1:41:19 PM / by Altruis

Revenue Cycle Optimization: Best Practices and StrategiesHealthcare organizations depend on revenue generation to continue providing services for their communities. When revenue lags, revenue cycle optimization can address the issue quickly as long as your billing team has enough expertise.

In this blog post, we’ll explain how to improve revenue cycle management (RCM) rapidly by working with a skilled and experienced RCM partner. 

What is the Revenue Cycle Management Process in Healthcare?

Medical billing tends to follow a predictable process, repeated thousands of times per year at a federally qualified health center (FQHC). The main steps in medical billing are as follows.

Registration

A patient is registered for the first time.

Responsibility

The facility establishes financial responsibility for the medical visit.

Visit

The patient checks in for their visit, receives care, and checks out.

Coding

Staff members conduct proper coding and billing procedures.

Claims

Claims are prepared and transmitted to the right payment sources.

Monitoring

Ideally, the billing staff will carefully monitor claims to ensure proper reimbursement.

Billing

Patients receive statements or bills.

Collections

Payments are processed and the facility pursues past-due collections.

Optimizing

Although the above sequence of steps is traditional in medical billing, revenue cycle optimization involves taking an innovative approach to re-examining each step and finding new efficiencies for better profitability. 

When Does Revenue Cycle Optimization Typically Begin?

When you work with Altruis, revenue cycle optimization starts the moment our partnership begins. Our team meets with your representatives, conducts a needs assessment, and gets to work refining your RCM.

If you’re concerned about our ability to move quickly, consider that most of our clients see immediate gains within the first month. A quick kick-off meeting gets the process moving, helps you understand our process, and builds buy-in among your staff members. 

Speed is never an obstacle when you work with Altruis. We work well under pressure. We recently helped a Kentucky FQHC increase claims by $1 million and counting. The FQHC’s CEO told us that without our help, they would have been facing closure. Now they have a steady 98% clean claim rate and net collections are at 95%.

Medical coding may need to move to an earlier stage in your revenue cycle and there may be a need for better staff training. In 2022, the Centers for Medicare and Medicaid Services enacted policy changes for payment of certain services, including telehealth and behavioral health. Ensure your process is up-to-date enough to incorporate these changes.

Physician credentialing is a step that can happen as soon as a new physician is hired and should not wait until patient visits or claims are already in process. This is a key factor in preventing rejections and denials.

We’ll also examine your approach to accounts receivable to find limitations and opportunities. Perhaps your days in A/R are too high and amounts due are allowed to linger too long without taking further steps to ensure reimbursement.

According to the American Academy of Family Physicians, the ideal number of days in A/R for financial stability is below 50 days at a minimum and preferably 30 to 40 days. However, it’s common for a busy FQHC to have 100 or more days in A/R, with reimbursements stagnating.

Medicaid claims are often a source of slow revenue for FQHCs. If your average days in A/R is at 40 days but your Medicaid A/R commonly hits 75 days or more, take a closer look at the source of the slowdowns. Is your rate of Medicaid denials far too high for some reason? Could we help you ensure these claims are paid more promptly?

How to Improve Revenue Cycle Management

Here are tips from Altruis for improving the revenue cycle management process and claiming more value from every instance of patient care.

Resource Allocation 

Reallocate resources to focus your in-house team on the most pressing needs. Free up resources to address persistent issues impacting your revenue. Consider working with an RCM optimization partner to make more progress.

Payer Portal Access and System Access

Improving RCM often comes down to accessing the right systems and sharing the right documented processes. This speeds up the understanding of contract locations, existing costs, and other factors affecting revenue generation.

Walk Through Current Processes

The Altruis team will work with you to walk through your existing processes and envision changes that could make a positive impact. We’ll shed light on processes your in-house staff could improve or areas where Altruis could step in to relieve their workload and allow them to focus on patient care.

Implement Revenue Cycle Optimization Quickly With Altruis

At Altruis, our goal is to help you build healthier revenue so you can better serve your community. We’ll ensure disruptions are minimized and your financial cycle flows smoothly.

Are you missing out on revenue? Could we speed up your revenue process? Find out now with a fast and Free Billing Assessment.

 

Request a Free Needs Assessment with Altruis

 

 

Topics: Revenue Cycle Management, Federally Qualified Health Centers, revenue cycle optimization

Altruis

Written by Altruis

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