How to Optimize Your Healthcare Revenue Cycle in the New Year

For healthcare organizations both large and small, employing a revenue cycle approach that is sensible and successful is critical to profitability. Simply put, if a practice can’t get paid on time, or paid at all, it can’t survive. Some organizations have struggled to have the most optimal revenue cycle in place. This may be due to a variety of reasons, including poor strategy and process, issues with technology, or personnel challenges.

As the calendar will soon flip to a new year, it’s the perfect time for healthcare organizations to re-think how they approach their revenue cycle. The first step would be to do a revenue cycle assessment to see where you might maximize your profitability for the next year. As part of that assessment, revenue cycle managers should ask themselves the following questions:

Key questions for revenue cycle managers

Are you doing enough insurance verification or eligibility training?

Knowing your patients’ benefits is crucial to know what they’ll be responsible for financially. Explaining their benefits to them in advance and giving them a clear idea of what they will be responsible for cuts back on business office calls, disputes and can save a lot of time on the back end. The training of your team on this knowledge is just as important as the explanation to your patients.

Is your “time of service” collection process efficient enough?

The revenue cycle truly starts at the front desk, and that’s where many issues begin. With many high deductible plans, a lot of payments will be coming from the patients directly. Having a credit card on file or collecting at the time of service prevents collections involvement, overhead in sending multiple statements, cuts back on business office calls and ensures that providers are going to get paid.

Do you have a system in place to monitor denials and accounts receivable?

Knowing your most common denials can give you insight to see if issues are preventable before they happen. You should answer questions such as: What’s your denial rate? Is there anything you can do to prevent those denials at the front end? Is it a coding issue? A prior authorization issue? Or is it a specific payer issue? For accounts receivable, make sure you are monitoring how much of that over the 90 to 120-day period. This can help you avoid timely filing denials and bad debt write-offs.

Are you getting paid your contracted rate?

If you aren’t monitoring your incoming payments, you could be getting paid a lower rate than your contract states, which could lead to the need for a reimbursement recovery audit. In addition, annually renegotiating those contracts is also key to getting a higher than or fair market fee schedule.

In addition to being prepared to answer these few questions, it’s imperative to stay focused on the bigger picture to optimize your revenue cycle. As things change often in the healthcare world, having procedures in place and training available at the outset is key to long-term efficiency.