With every new year comes resolutions and the desire to make positive changes. When it comes from within your practice, the results can unify your team and streamline workflow.

The beginning of a new year is a perfect time for medical professionals to dive in to see what worked in the previous year and identify areas that could use improvement.

Revenue Cycle Management (RCM) is an excellent place to start. Managing revenue is important in many businesses but may not be the primary focus in healthcare. However, providers need this income to pay for medical supplies, salaries, office locations, and more.

The overall goal is to increase revenue in each step of the RCM process by identifying areas of friction.

The first area to focus on is the front-end. Invest in your front office staff. They play a crucial role in the RCM process. By recruiting qualified people and training them to capture the right information, it prevents back-end challenges. Most claim denials are preventable, many being the result of missing or incorrect information.

But even before the patient visits the office, it is important to verify eligibility and benefit information with their insurance provider. Verify that the plan is active, whether the service needs an authorization, and collect payment details such as copays or deductibles. Accurate insurance verification ensures a higher number of clean claims and speeds up the billing cycle. Also, being transparent about financial information will result in a happier patient and ensures you will receive your payments quicker.

Creating a system to submit claims promptly and accurately is crucial for quick turnaround and faster reimbursement. As mentioned, patient demographics and insurance information on claims are extremely important, in addition to making sure that specific coding guidelines are followed, the correct modifiers are being used, as well as accurate documentation is completed and signed. Taking the extra step to look over the claims before submitting them can save time and money in the long run.

Even with a well-established workflow for submitting insurance claims, denials will still occur and need to be addressed quickly. Research indicates that 50% to 65% of denials are never reworked. Designing a convenient and efficient process to follow up on denials is extremely important. The sooner they are addressed, the better the chances are the claims end up getting paid.

Looking into digital solutions to streamline the RCM process can also be an effective and worthwhile area to explore. We live in a digital world and need to learn to adapt. With online patient portals, patients can register for appointments, get price estimates, or even pay bills.

For some practices, the best choice may be to outsource medical billing. Integrating a trusted medical billing company into your current workforce allows you the time to focus on patients. With outsourcing, you can gain control of revenue and streamline the business process.

Improving RCM is essential to boost your bottom line and reduce claim denials. By taking the time to figure out what changes need to be made and implementing them, you can meet your new year’s goal of a healthy RCM so you can better connect with your patients and increase revenue.

At Reliance Medical Billing Solutions, we make medical billing simple. For more information, visit our website at www.reliancembs.com or contact us at 717-740-2622.