5 changes to make to your RCM workflow to get the biggest impact on revenues

What are the two most important factors that determine the success of your brand? Most healthcare providers would say patient experience and revenue generated. This is such an interesting answer because both of these factors are interdependent. Offering an exceptional patient experience would improve brand loyalty and customer feedback, thereby bringing in more patients and better revenues. Handling your revenue cycle management services right, on the other hand, makes billing more transparent, quick, and hassle-free, thereby adding to a better patient experience. 

Most healthcare brands have extensive policies and processes to improve the patient experience. However, what is the best way to improve your revenues? Building a robust RCM workflow could be the answer here. 

What is an RCM workflow?

A revenue cycle management service workflow is a set of steps to be followed so the providers can get paid for the services rendered. For most practices, the workflow may start with documentation and eligibility verification and end with denial management and payment posting

All RCM service providers would have their own version of the workflow in place. As a practice, you must first check if the flow matches your requirements. Here are five changes to make to your RCM workflow to achieve maximum revenue.

1. Strengthen your medical billing transmission service

At a time when 100% of patients paid out of pocket, medical billing could have been pretty straightforward. 

In the United States, more than 92% of people have some kind of medical insurance attached to them. This means the insurance providers become the primary payers. 

Each of the insurance policies is different in terms of coverage, allowances, authorization needs, and eligibility. That’s why medical billing transmission service is one of the most complex revenue management processes. However, getting this right before proceeding to other fancier changes in your RCM workflow is imperative. 

Medical Billing is the foundation of RCM. Unless that is nailed down, nothing else may matter. In Quintessence, we deploy a mix of human expertise, automated tools, and AI bots to precisely value charges and maximize your revenue potential. 

2. Divide and conquer RCM workflow

We spoke about strengthening your medical billing transmission service at the prior point. This can be considered an extension of that. How do you conquer something? By diving and ruling. 

In most cases, the revenue cycle management process offered by your internal team or a service provider can be divided into three categories.

  1. Front-office services include typical appointment scheduling, documentation, patient data management, prior authorization requests, and eligibility & benefits verification processes. Consider these the foundations for a seamless workflow.
  2. Mid-office services include actual billing, coding, audits, charge entries and reviews, and edit processes. This is the heart of the RCM workflow and directly determines the quality of claims generated.
  3. Back-office services include processes that occur after sending out a claim to the payer. This includes payment posting, handling denials and rejections, and A/R management. 

You can have different strategies to divide and conquer. Some service providers may choose different teams to handle different segments to ensure each is dealt with correctly. Other providers may audit to identify which segment is struggling to keep up and then invest in corrective measures. Either way, splitting medical billing transmission services into smaller segments helps you perfect it in all aspects.

3. Optimal staffing

If you are this generation’s revenue cycle management service provider, you will have two kinds of staff to work for you – humans and bots. This may sound funny, but in reality, most RCM processes are already automated and done by bots and software.

So, optimizing both workforces effectively is the trick to getting the most significant impact on revenues. Tools and bots are huge one-time investments, but they can keep working 24/7 with the same productivity levels. Does that mean you can let go of most of your human workforce?

Unfortunately, the answer isn’t that straightforward. Human billers, coders, and A/R specialists bring actual working experience, creativity, and out-of-the-box thinking that the bots haven’t yet mastered.

Your denial management specialist/executive may have a personal connection with the payer’s team and quickly resolve an issue that may take the bot multiple attempts, emails, and reminder messages. 

So optimize your staff so you get the best of both worlds, and that’s the best way to maximize revenues.

4.Hire follow-up teams

Follow-up teams usually follow up with the stockholders  – they could be patients, payers, debtors, or co-payers. This dedicated team gets in touch with people and tries to find quicker and easier solutions to problems that may take weeks to resolve over emails. 

You will be surprised at the drastic increase in revenue that a small follow-up team can bring in by just calling and reminding people to process payments. 

5. Invest in a denial recovery team 

All revenue cycle management service providers offer denial management services. However, very few have denial recovery services. What’s the difference, you may ask? The difference is that it is between a police force and a special task force. The police force picks up all small and large cases in the area, and they succeed in some and miss a few. 

On the other hand, the special task force hand-picks extremely sensitive or important cases and ensures they solve them. A denial recovery team will pick those soft denials of extremely high value and do everything possible to try and reverse the denial. The recovery team may only have worked on one-fifth of the denials handled by the denial management team. 

However, when you compare the wins and the revenues recovered, denials recovery is the way to go. 

Conclusion 

Having a standard RCM workflow and having one that’s highly tailor-made to suit your business needs is the most significant difference between struggling to make even and hitting the goal revenue regularly. 

Tweaking your revenue cycle management services exactly right is like laying a robust and solid foundation for your house. Once this is done, the rest of the processes can be implemented confidently, knowing the foundation will hold through. 

Quintessence and our team of expert human and bot workforce can help create such an influential RCM workflow that uplifts your revenue generation to levels untouched in the past. Get into a call with our team to learn how this can happen quickly, within your budget, and on your terms and conditions. 

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