The Intake

Insights for those starting, managing, and growing independent healthcare practices

Revenue cycle management in 2024: Achieve clean claims

Your clean claims rate can be more within your control. Learn how to improve revenue cycle management with these actionable tips.

Diagram depicting claims care rcm

At a Glance

  • Set realistic revenue goals for your medical practice by analyzing your expenses, desired income, and number of patients needed to meet those goals. This will help create a sustainable business model.
  • Prioritize patient financial health through transparent billing and automated processes to maximize accuracy and revenue while minimizing risk — building patient trust and loyalty.
  • Embrace revenue cycle management by looking at scheduling, claims processing, and payment collection. Use data analysis to drive informed decisions and optimize your practice’s financial performance.

Do you feel like you’re fighting a constant uphill battle of claim denials in your revenue cycle management? If you answered yes, you’re not alone in your frustration and exhaustion. Like all of your practice’s processes, you want revenue cycle management to be efficient and effective. But how are you supposed to do that when more claims are being returned than ever?

This article will help you:

  • Develop an action plan to achieve your goals
  • Prioritize patient financial health so you can drive long-term growth for your practice
  • Embrace the revenue cycle to optimize your practice’s financial performance
  • Leverage business intelligence to drive informed decision-making

Maximizing revenue while realistically managing expenses is a challenge for any business. Your practice is no exception. The bad news is there isn’t a quick fix to smooth out your revenue cycle management. The good news is, once you and your staff make some necessary decisions and implement associated strategies, your practice can run more smoothly.

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The importance of effective revenue cycle management

You may have become a physician to provide valuable treatment, help people make better decisions for their own well-being, carry on a family practice or career tradition, develop new treatments, or another reason altogether. 

Whatever your reason, whether you run a small independent practice, work in a collective, or practice within a larger organization, revenue matters to your practice’s longevity. 

Because many legal and ethical issues are associated with how you bill patients, you must take a realistic look at your practice’s business model. ”

Because billing involves many legal and ethical issues, taking a realistic look at your practice’s business model is important. Ask yourself where you want your practice to be in the next 1, 3, and 5 years. What is the best way to keep your practice healthy while fully complying with regulatory requirements? Below is a guide to help you navigate these decisions.

Decision 1: What are your revenue goals?

Medical school didn’t prepare you for the business side of healthcare, but it’s not too late to catch up. Part of establishing your revenue goals is to conduct a realistic analysis that considers:

  • The income you need to cover your expenses
  • How much you want to make above that figure
  • The number of patients you need to see throughout the year to meet that goal

Next, brainstorm how to make that goal. If you feel it’s out of reach, reevaluate. You may need to revise your goal or become more creative about how you plan to meet it.

Considering the business side of your practice doesn’t mean that your patients become numbers and dollar signs — they’re people with unique and individual backgrounds and stories. However, in order to continue to support them, there’s the reality of how you holistically approach running your practice.

Decision 2: How do you create long-term growth while prioritizing patient financial health?

You don’t like to receive shocking bills that you didn’t anticipate. Patients don’t either. As a result of the divide between insurance companies that guide in- and out-of-network care, Congress passed the No Surprises Act in January 2020 to improve patient billing transparency.

Trying to stay ahead of the continually changing landscape while keeping up with treatment advancements and growing your practice is enough to bring on burnout. Primary care providers already need 26.7 hours in the workday to keep up. The time management associated with manually managing your practice’s billing would be overwhelming.

Technological advancements have made automated or robotic billing accessible. These processes save you, or your office manager, a significant amount of time and improve your practice’s efficiency while increasing profitability.

Technological advancements have made automated or robotic billing accessible. ”

These automated processes ensure you use the most accurate codes to safeguard accuracy, maximize revenue, minimize risk, and contribute to your patients’ financial well-being.

Decision 3: Embrace revenue cycle management to optimize your practice’s financial performance

The business revenue cycle for your practice involves 3 different areas of the patient lifecycle:

  1. Patient scheduling, registration, and treatment
  2. Claims processing
  3. Payment collection

Thinking about how revenue relates to your relationship with your patients may be uncomfortable. Still, the reality is they know there is a fee for your services. Offering as much transparency and information as possible around what their insurance will and won’t cover can empower them to make informed decisions about their care.

Ensure the front office collects active insurance information for each individual when they register as a patient and check in for an appointment. Automated billing processes incorporate relevant patient insurance information with a myriad of billing codes.

Using the technology gives you a picture of what the insurance will and won’t cover as you enter treatment codes. This opens up the opportunity for honest dialogue with your patients.

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Decision 4: Will you drive informed decision-making by leveraging business intelligence?

Understanding the efficiency and effectiveness of your practice is more than anecdotal. It’s essential to have hard data at your fingertips that will provide valuable insight, expose opportunities for improvement, and highlight areas that are going well.

Using technology to find trends by analyzing defined metrics allows you to focus on and prioritize areas you want to change or improve.

Revenue cycle management doesn’t have to be overwhelming

Taking advantage of viable technological solutions will make evaluating your practice’s position in your revenue cycle easier. Determine how efficient and effective you and your staff are being so you can ensure happier patients who will have a long-term relationship with you as their provider of choice.

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How to Beat Medical Billing Challenges

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Written by

Karmin Gentili

Karmin Gentili has been a freelance writer and editor since 2016. She has over 25 years of experience in corporate HR and compliance consulting. She has worked to further elevate her skills by pursuing and receiving multiple certifications, including copywriting, video scriptwriting, effective content positioning, case study writing, and SEO. Her love of writing motivates her to use those skills to develop content for the medical field that ensures others can work toward achieving their goals.

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