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How to succeed with better Revenue Cycle Management

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By Health Prime on April, 29 2021

The way you manage your revenue cycle impacts your medical practice and could prevent you from getting paid for your work. Adjust your strategy and succeed in the way you are managing your RCM with these tips.


The business of healthcare has been getting more and more complicated for physicians.


With rising deductibles and tighter payer reimbursements, this year promises to be even more challenging for providers working to take care of patients while improving their collections. Managing the money tied to patient encounters at each step of the process is complex. That's why, in today's healthcare economy, revenue cycle management (RCM) is crucial. Getting it right is essential to the financial viability of any healthcare organization.


On this context where patients are increasingly paying more of their healthcare expenses out-of-pocket and insurers are requiring more data, how can practices improve their RCM? The answer is an approach that includes a combination of improvements to internal processes; deployment of sophisticated and customized technology tools; and, strategic partners with the right expertise.


Let's take a closer look at why RCM is increasingly making providers stumble and how to adjust your strategy to succeed: 



Trending toward more challenges, not fewer

Consumer trends such as high-deductible plans are resulting in a shift in payment obligations. These plans mean patients are faced with paying a greater portion of their healthcare expenses out-of-pocket. As patients see out-of-pocket costs rise, they are facing more difficulty paying, or paying on time. For providers that translates into greater challenges recovering payment from patients.


Moving from a fee-for-service to value-based approach also presents RCM challenges as providers face navigating through ever-changing insurer compliance requirements. This means time and resource intensive processes require the highest levels of quality to assure reimbursement.


With these constant changes and soaring complexity, internal staff's dwindling time hinders the practices' ability to recover maximum reimbursement. These challenges, combined with more physician burnout and lack of internal expertise, keep providers from focusing on RCM and the changes necessary to improve it. The result: money is left on the table. And usually a lot.


Data matters

For already over-burdened physicians and staff trying to manage revenue cycles, mistakes are made when decisions are driven by limited or no data. For most health care organizations the only available data comes from practice management systems, which aren't comprehensive enough to be of real value.


It's essential for practices to have sufficient data and a clear understanding of what it means. Lack of granular insights makes it nearly impossible to make effective strategic decisions to effectively manage and ultimately drive revenue.


At Health Prime, we can assist you with that. Health Prime Datalytics is our own business intelligence platform that focuses on insights that other medical billing solutions neglect. Datalytics can help you monitor key performance metrics on your medical practice, keep track of your trends, and implement process improvements based on that valuable data. 


If you want to know more about how Datalytics can help you improve your medical practice, keep current with all the updates about our platform, and discover why it is the best thing for your business you can subscribe to our Health Prime Datalytics blog


Improve processes

Many billing cycle problems can be resolved before the patient ever receives care. This is where an expert can provide value developing, training staff, and executing pre-visit procedural best practices such as registering patients, entering demographic information, verifying and scheduling appointments, and clearly explaining payment policies and procedures.


Improved billing and collections—from claims submission to final reimbursement—must be examined and optimized. Usually this happens most efficiently with a trusted strategic partner that brings deep knowledge of modern health care practice realities, as well as technology expertise and tools.


Bringing it all together

Patient and insurer trends, data, technology, and back-end processes factor heavily into a practice's RCM success. When protocols and processes are not thoughtfully considered and implemented, a ripple effect can significantly delay reimbursements, lower margins, and negatively impact the bottom line. Identifying and addressing the challenges is no longer an option but a requirement for healthcare organizations to thrive now and into the future.


If you would like to learn more about how to improve the way you are managing your revenue cycle or if you have any questions, please email us at or visit us at: Set up a meeting with us to discuss how Health Prime can help you get your practice back in its prime. 


Make sure you subscribe to our Health Prime blog to receive all the latest updates on how to improve your medical practice and make sure you are getting paid for your work.

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