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5 Strategies That Can Rebuild Revenue Cycle for Healthcare Facilities

May 27, 2021/7662 views / 0 Comments/in BLOG, Data Integrity, Denied Claims, healthcare, Medical Record Mix-ups, Patient Data, Patient Experience, Patient Identification, Patient Outcomes, Patient Safety, Revenue Cycle Management /by Matt Gibson

As the pandemic wanes, at least for now, many businesses are rebuilding. The US healthcare sector is no exception, picking itself up and dusting itself down gingerly, preparing to welcome back patients and see an uptick in revenue again. Working on the revenue cycle for healthcare providers has never been more important.

For some hospitals and departments, it’s already too late – the pandemic forced them to close. Others are hanging on, with staff returning from furlough and machinery being switched on and recalibrated for the first time in over a year. As more people are fully vaccinated, it becomes simpler to see patients in person again, which will lead to the increase in revenue the healthcare sector badly needs. However, it’s not all plain sailing. Providers could still lose over $120 billion this year, so it is vital to be careful with any attempts to ramp up income. The fewer denied claims there are, the better the bottom line will be. That being said, let’s take a look at some strategies that will help optimize the revenue cycle for healthcare providers.

5 strategies to enhance revenue cycle for healthcare providers

Check the existing revenue cycle management processes

The first option is to see whether any immediate improvements can be made to the existing system. This will be down to the back-end developers and IT specialists and will not be visible to patients. After that, it’s time to look at the patient-facing part of the cycle. Ensuring staff members are fully trained in customer service is a good place to start with optimizing revenue cycle management. That way, they will know what questions to ask when registering or checking in patients and how to check their insurance, treatment codes, and eligibility. They will know how long to allocate for different types of appointments and when to ask for immediate payment.

Use technology to your advantage

The easiest way to ensure that everything runs smoothly is by identifying patients accurately right from the start of the treatment process. This could be done using a patient identity verification platform such as RightPatient that eliminates the need for asking patients questions, patient record mix-ups, and more, reducing denied claims in the process.

That was just one example – optimizing the revenue cycle for healthcare providers is not difficult, it just needs a bit of help at times. Technology can be that hidden assistance.

Prompt, correct coding, and billing is key

An organization should not expect prompt payment if its internal processes are lax. Ensuring accurate coding and billing leads to lower chances of denied claims. Complete elimination of denied claims is impossible, because of some uncontrollable factors, but rigorous checking of coding will, in turn, generate accurate bills which are more likely to be agreed on the first time by the insurers.

Utilize up-front collection

If possible, the up-front collection is the best way to optimize the revenue cycle for healthcare providers. This eliminates an entire step in the revenue collection process, as the bill does not need to be seen by accounts receivable at all. Instead, it lands on the collected revenue team’s side for processing. While this approach will not work for every patient, it can be an effective tool for immediate revenue generation.

Accurate patient identification underpins everything

Well-trained staff members are likely to know exactly how to identify a patient and take payment politely using a fast processing system, but the whole thing falls if the patient’s identity is incorrect on the system, or if changed details are input wrongly. Denied claims are annoying and time-consuming to rectify. There are ways in which technology can help minimize the chances of this happening, however.

Getting the patient’s identity and billing details correct from the first interaction with them makes things so much smoother. It prevents duplicate medical records and overlays, for a start. If a patient only has one EHR, there is little to no chance that the insurer will find fault with the claim and so will settle the amount faster. Denied claims cost millions of dollars for every provider, often due to poor electronic health records and a lack of robust identity checks. Incorrect patient identification puts the patients at risk too.

One of the most innovative ways of ensuring accurate patient identification from the get-go is by using RightPatient. This touchless biometric patient identification platform is being used by several healthcare providers and has several benefits. It allows patients to identify themselves even in virtual consultations and during in-person visits, all they need to do is look at the camera, meaning that they don’t have to run the risk of others overhearing sensitive personal data when checking into a clinic. Nor do they have to use touchscreens or keypads to enter information – making it hygienic and safer than ever.

RightPatient is the solution that ensures accurate patient identification, reduces denied claims, duplicate medical records, and ensures fast billing.

Improving Revenue Cycle in Healthcare Facilities in a Post-Pandemic World

May 25, 2021/6854 views / 0 Comments/in BLOG, Data Integrity, Denied Claims, healthcare, Patient Identification, Patient Outcomes, Revenue Cycle Management, Telehealth /by Matt Gibson

The pandemic hasn’t only been difficult for the healthcare sector in terms of the number of patients treated and the severity of symptoms. For the American healthcare system, it meant a huge loss of revenue for everyday treatments, as every available resource pivoted to caring for the patients affected by COVID. Those facilities that couldn’t pivot were left with no option but to close and file for bankruptcy as their income was hit. Some managed to survive by furloughing their staff or redeploying them to care for the large number of seriously ill patients which COVID produced. As a result, revenue cycle in healthcare facilities took a huge hit.

Some organizations, though, were luckier than others and were able to deploy remote triaging and virtual consultations by phone and video using the latest videoconferencing software – all of which can be bolstered by utilizing a touchless biometric patient identification platform such as RightPatient. This allowed them to continue to treat patients, and earn income, which softened the blow to their finances and helped both patients – who suffered no break in treatment – and staff – who were retained rather than furloughed.

Revenue cycle in healthcare facilities during the pandemic tanked, to put it mildly. Normal service dropped off a cliff and around three-quarters of healthcare providers had to put revenue cycle management in place, as well as ensuring employees could practice remotely and maintain effective social distancing when they did have to attend their workplace.

The return has started, remotely

Now that treatment cycles are returning to pre-pandemic levels in many places, the staff members are also returning to their usual roles. They are returning to treating their regular patients and making sure of their incoming revenue whilst minimizing the losses their facility may have suffered.

In order to optimize their abilities, staff members have learned how to use technology to help them assist patients remotely during the pandemic. This approach is likely to remain in place for those patients who are unable for any number of reasons to attend an in-person consultation.

One of the most popular ways to use tech in medicine is by organizing a remote consultation, by telephone or video call. This helps staff to find out quickly what ails their patient and can help them triage the patient more effectively, immediately. They can tell the caller at once whether they need to attend, offer an appointment if so and have all the notes from the call available when the patient comes in. If a referral is needed, the process can be started straight after the phone call, without waiting for an appointment or paperwork.

Of course, processes still need to be followed. Not only does that enhance patient safety, but it also embeds the familiar for both patient and healthcare employee. Sorting out the paperwork before the patient arrives is of prime importance, and means everyone will know what is going to happen and what they can expect to be billed or paid for. Staff should check whether there is an authorization for the service under the patient’s insurance and what the patient’s responsibility is regarding this. Ensuring everyone is aware of charges and can reconcile them quickly is better for the provider’s income levels too. Being organized allows accurate expenditure planning, which helps everyone balance incoming revenue against outgoing expected payments.

Communication is key for improving revenue cycle in healthcare

Face-to-face, by email, text, shared app, or phone: no matter how teams communicate, it is best that they do. Patients with comorbidities or multiple conditions need dovetailed treatment, a patient pathway across several providers, and it is best to schedule appointments logically. Scheduling several simple appointments across nearby providers in one day is a possibility to reduce travel headaches for the patient, although it may make it an expensive time when the bills come due. That also relies on the finance and revenue cycle team knowing that they are to bill a particular insurance company for a defined treatment to a named patient on a given date. Communication makes all of these processes simpler and can help provide the necessary paper or electronic trails to ensure timely billing, and therefore prompt payment. The notification to finance should come from the clinical team, as they are treating the patient. They also know exactly which procedure was undertaken and how, so are best placed to ensure the billing is correct.

An efficient billing cycle is one way to ensure reliable income, as everyone knows what is due to be paid, by whom, and when. It’s not just the medics and revenue billing team who have a part to play here either. Every healthcare professional who attends to the patient has a responsibility to produce documentation for their part in the patient’s care – all of this works towards optimizing revenue cycle management in healthcare facilities.

Technology can enhance revenue cycle in healthcare facilities

Accurate billing is essential when attempting to collect revenue. Billing the wrong patient, or a different insurance company, can delay payment and cause extra effort and paperwork for no gain. Correct patient identification at the start of the treatment cycle makes billing much simpler. A biometric touchless platform such as RightPatient can help eliminate patient misidentification and the nearly $5 million of denied claims which result.

5 Strategies to Ensure Revenue Integrity in Healthcare

June 9, 2020/10235 views / 0 Comments/in BLOG, Clinical Efficiency, Duplicate Medical Records, Facial Reciognition, healthcare, Iris Recognition, Medical Identity Theft, Patient Identification, Patient Matching, Patient Safety, Revenue Cycle Management /by Ryan Stephens

Many healthcare providers were struggling financially before the pandemic. But now, the U.S healthcare industry is on the verge of financial disaster. According to the American Hospital Association, hospitals are bleeding approximately $50 billion per month due to canceled elective procedures and costs associated with treating COVID-19 patients. Many non-COVID patients have also stopped seeking primary care visits, including patients with life-threatening conditions, because they are worried about exposures. In addition, claim errors, denials, and payment delays that result from inaccurate patient identification, duplicate medical records, and medical identity theft still persist, all of which affects revenue integrity.

Adopting Value-Based Reimbursement (VBR) models has shown to have economic advantages but poses a real challenge for healthcare providers alongside ever-changing healthcare compliance regulations. Siloed workflows, data proliferation, and disparate systems make it difficult to achieve the collaboration that is needed for VBR to yield optimal results. However, intelligent revenue cycle management can be the key to achieving financial stability and revenue integrity.

Identify the problem

Today’s environment requires automating workflows and considering the whole revenue cycle process to ensure revenue integrity. Healthcare providers want an easy, seamless way to manage revenue cycle without errors, such as those caused by patient identification issues. Considering the lack of electronic medical record (EMR) system capabilities to adequately address the critical need for accurate patient identification, it is vital to leverage complementary technologies with core-specific competencies that can improve the overall revenue cycle. For example, improving patient identification and matching processes at the front-end of the revenue cycle process can significantly reduce costs.

As an industry-leader in touchless patient authentication, RightPatient has been helping many healthcare organizations reduce claim errors and denied claims by ensuring accurate patient identification. By eliminating denied claims linked to identification errors, healthcare providers can reduce the burden of back-end activities in the revenue cycle and simplify the reimbursement process to ensure revenue integrity.

Rely on technology

Adopting technology is also essential to ensure that clinical teams across the healthcare ecosystem are accessing high quality shared data to produce the best outcomes. Augmenting the organization’s core systems with complementary technologies on a single, integrated platform enhances internal collaboration with other teams or departments. For instance, RightPatient crosses departmental silos and brings transparency to patient healthcare data across disparate domains. Transparency across teams is critical. RightPatient will ensure that a holistic and accurate medical record of each patient can be accessed by clinical and operational staff members no matter where the patient is authenticated. By automating the patient identification and authentication process, RightPatient improves clinical outcomes and enables staff to proactively focus on other areas where their expertise has the most impact.

Ensure compliance

According to the National Association of Healthcare Revenue Integrity (NAHRI), the goal of revenue integrity is to prevent issues that lead to revenue leakage or compliance risks through effective, efficient, and internal controls across the care continuum, supported by strong documentation and sound financial practices that can withstand audits at any time.

Violation of healthcare compliance is a major contributing factor to financial losses. For instance, HIPAA violations are becoming more common across the U.S healthcare system. HIPAA compliance software, on the other hand, can help address this issue. Such software allows healthcare providers to simplify their compliance efforts and manage training through an effective communication system. Ensuring HIPAA compliance prevents privacy issues that can impact proper revenue cycle management and helps to avoid costly financial losses.

Accurate documentation and coding

Unfortunately, as long as healthcare providers do not address the issue of front-end data validation, claim denials will continue to wreak havoc. Inaccurate patient identification and medical identity theft still remain a major contributing factor to denied claims and payment delays. However, through accurate patient identification, RightPatient enables healthcare providers to bill and code each patients’ information accurately. By ensuring accurate and clinical documentation, this platform significantly reduces inefficiencies of denials and rework, thereby strengthening revenue integrity.

Improve hygiene and foster patient trust with RightPatient

Healthcare providers are witnessing a reduction in non-infected patient activity due to the fear of COVID-19. Visits for general check-ups or other routine procedures have decreased to the obvious financial detriment of healthcare providers. These providers need to reassure their patients that they are taking all precautionary steps to maintain hygiene and control this contagious disease. Adopting RightPatient is a sensible part of this strategy.

RightPatient is a completely touchless biometric patient identification platform that can accurately identify patients throughout the continuum of care. After capturing a photo from a smartphone, tablet, or webcam, RightPatient instantly identifies patients and retrieves their correct medical record. By securing unauthorized access to medical records, hospitals are able to prevent medical identity theft, reduce denied claims, and duplicate records – all of which are vital to a high-performing revenue cycle.

RightPatient also offers remote patient authentication, which is becoming increasingly necessary as people are maintaining social distance by staying at home and getting treatment through telehealth practices. During this process, RightPatient validates patient identities by comparing their ID (e.g. driver’s license) and selfie photos. This process can also help healthcare providers to save money on more expensive identity proofing solutions through credit agencies.

As patient care becomes more complex, so does the management of the revenue cycle. RightPatient can help to simplify and manage the complexity by ensuring safe, ubiquitous patient authentication from various patient encounter points. Full financial recovery from this pandemic may take years, but adopting RightPatient will ensure that you are on a faster path to success.

At the Becker’s Conference, learn how RightPatient prevents patient fraud

September 19, 2017/9626 views / 0 Comments/in BLOG, Events/Conferences, healthcare, Medical Identity Theft, Mobile, Patient Identification, Patient Safety, Photo Biometrics, Privacy /by Michael Trader

The Becker’s 2017 (and 3rd annual) Health IT & Revenue Cycle Conference is only a few days away! Needless to say, we’re excited, and it’s not just because George W. Bush and Sugar Ray Leonard will be there. The conference has a great lineup of speakers, presentations, and, ahem, vendors like RightPatient that will be providing a wealth of information on a variety of important topics.

The timing of this conference could not be better considering the recent Equifax data breach, which puts over 140 million Americans at risk of identity theft. This has serious implications for healthcare, but the good news is that patients and providers can mitigate their risk with RightPatient.

Since our inception, we have always recommended Photo Biometrics with RightPatient and have never deviated from that position. This didn’t come out of left field; we are, by far, the most experienced vendor in our market segment with 15 years of experience in biometric technology. We have worked with many biometric modalities, implemented our technology in projects around the world, built some massive biometric matching systems, and generally know this stuff inside and out. That’s why we always knew what was best for healthcare and had a vision of how Photo Biometrics would be used with our platform to transform the way that patients are identified.

RightPatient accurately identifies patients by simply capturing their photo. At provider locations, this is critical to prevent identification errors and medical record mix-ups that affect patient safety, revenue cycle, and data integrity. With 1,000 patients dying each day from preventable medical errors and hospitals writing off millions of dollars annually from denied claims and patient fraud, health systems should have an easy time justifying RightPatient.

But, for good measure, we now have the Equifax breach. Patient fraud was already a serious issue with 2-10% of patients showing up at the ED and providing false information (I’m looking at you, frequent flyers). We’ve heard countless stories from customers before they implemented RightPatient about frequent card sharing and outright fraud that was costing them millions in annual write-offs (RightPatient has since eliminated these issues). With the personal data of over 140 million Americans now compromised, how much easier will it be for someone to obtain care, access healthcare information, or gain a medical record release under a stolen identity?

Here’s the bigger question – why deal with any of these risks at all? For a small monthly fee, healthcare providers could implement RightPatient and solve these issues. When patients interact with their providers, RightPatient captures their picture and accurately identifies them. The service is contactless (ideal for hygiene/infection control), supports mobile devices (e.g. EMTs, unconscious patients, home health visits), and the patient photos that RightPatient simultaneously captures deliver unparalleled value in various ways.

If you have a chance, stop by our booth #1003 at the Becker’s Conference to check out why RightPatient is transforming patient ID in healthcare and to learn about our vision. We look forward to seeing you there!

New Partnership with CrossChx Signals Positive Changes for Patient ID

July 17, 2017/6427 views / 0 Comments/in BLOG, Comments On Recent Biometric News Stories, Future of Biometrics, healthcare, Partnerships /by John Trader

In case you missed it, on Friday we officially announced a new and exciting partnership agreement with CrossChx. Under the terms of the partnership, CrossChx customers can easily transition their existing SafeChx biometrics solution to RightPatient, while continuing to utilize other CrossChx products such as Olive artificial intelligence.

Announcing a new partnership with CrossChx to help expand the use of biometric patient ID tech in healthcare.

The healthcare industry continues to suffer the ill consequences of inaccurate patient identification, jeopardizing patient safety and the quality of care. RightPatient helps to alleviate patient misidentification and instantly and accurately identifies patients by capturing their photo. This photo is linked to a patient’s unique medical record and travels with them throughout a healthcare provider’s network to ensure safety during care delivery. Plus, clinicians at hospitals that use our patient identification service have commented that they love having a patient’s photo before administering services to help humanize care delivery and help patients feel welcome instead of just thinking they are a name and a number. We love to hear this!

Take notice because the winds of change are shifting for patient identification in healthcare. More providers recognize and understand the advantages and benefits of modernizing their patient ID technology and many are taking a very close look at the advantages that our service offers. Keep in mind that implementing a biometric patient identification service offers additional advantages above and beyond patient safety – most notably improvement in revenue cycle management, increases in patient data integrity, and prevention of fraud and medical identity theft at the point of service.

Read more about our new partnership with CrossChx here.

Have questions? Drop us an email at: info@rightpatient.com

7 Tips to Improve Your Revenue Cycle Management in 2017

April 21, 2017/5376 views / 1 Comment/in BLOG, Guest Blog Posts, Patient Safety, Revenue Cycle Management /by John Trader

The following guest post on improving revenue cycle management in healthcare was submitted by Yeshwanth HV.

Amid the ever-changing regulatory environment, Revenue Cycle Management (RCM) has become one of the most important concerns for healthcare leaders in the US. Effectively managing it ensures that there will be lesser accounts receivable, fewer complications and speedy recovery of patient payment, all of which will make a healthcare practice more efficient and responsive in terms of operational changes and growth. However, effective management of the revenue cycle has proven elusive to the providers in the current healthcare landscape. The good news is there are specific ways in which you can achieve this elusive feat. Here are seven tips that will help you to effectively manage your revenue cycle:

Follow these 7 practical tips to improve revenue cycle management at your healthcare facility.

Set Benchmarks and Measure Them

Lord Kelvin, a famous British mathematician and engineer, once said: “If you cannot measure it, you cannot improve it.” This is very true with regards to healthcare, especially if you are thinking on the lines of improving the efficiency and productivity of your RCM practices.
Hence start by identifying a set of benchmarks that are most important for the success of the organization such as average time taken to submit a claim, average reimbursement rate, and so on. If necessary opt to use comparative data from your competitors to keep you on the right path. Next measure the performance of your practice using the benchmarks that you have zeroed in on and see to it that you slowly improve your performance over time.

Get the Money You Are Owed

While evaluating the performance of metrics as suggested above, make it a point that you also keep a close watch on the collection rate. Tracking these metrics helps you to make sure that you don’t leave a significant amount of accounts in collections on the table, which can impact the financial stability of your practice.

An ideal RCM practice should be able to recover around 96% percent of accounts in collection. Take appropriate measures to bring your rate up to this mark or at least ensure that your collection rate is above 85 percent so that percentage of patients with outstanding bad debt will not get out of hand.

Audit Workflow

Conducting a regular audit of your typical RCM workflow – from patient scheduling to final claim submission – is a great way to streamline your operations. It helps you to discover issues and inefficiencies that may be hampering your ability to process claims in an expedient manner.
But make sure that you include your frontline staff in this process by taking feedback from them about things that are holding them back. This may help you uncover crucial flaws that you may have overlooked or taken for granted.

Track Denied Claims

Tracking every claim that is denied will help you to identify trends in mistakes with regards to billing, coding and other RCM related processes. The insights gained through these discoveries can be used to train your resources and augment your RCM practices.

Look Ahead to Regulatory Changes

Rules governing healthcare are in a constant state of motion. For instance, consider the last five years. First, it was the Affordable Care Act (ACA), then ICD-10 implementation and now it is a possible repeal of ACA. In such an ever-changing environment, it is always beneficial to make it a regular practice to stay aware of new statutes, guidelines, and codes that might come your way, and be prepared with effective counters to avoid revenue cycle disruptions arising due to these changes.

Pay Attention to Self-Pay Balances

A rise in the popularity of low-premium but high-deductible plans is likely to correspond with a rise in self-pay balances. And this can pose a serious challenge to the financial stability of practice, just like in the case of accounts in collection.
To mitigate the hurdles posed by this trend, you have to be proactive and find out a way to work with individuals so that their accounts do not have to go into collection.

Make Sure Your Current RCM Practice Meets Your Needs

Never take anything for granted and make it a standard practice to periodically question the value that your RCM system offers. Also make research ongoing into pricing, service offerings, and the latest software systems so that when your RCM system is lagging, you are perfectly aware of things that need to be done.

The Bottom-line

Navigating through the chores of today’s healthcare landscape is not easy. To be successful in such an environment, healthcare practices should be prepared to undertake a transformational RCM approach that focuses on improving the function as well as the flow of each moving part.

Author Bio: Yeshwanth HV is a healthcare writer at MedBillingExperts, a leading provider of healthcare business process outsourcing services such as medical billing, medical coding, and revenue cycle management services to medical practitioners and healthcare organizations worldwide. Dedicated to the healthcare industry, he has authored several blogs and articles that have received rave reviews in the industry. Prior to MedBillingExperts, Yeshwanth worked with CIO Review and has authored several bylined pieces for the quarterly editions of the magazine.

Ensuring the Right Patient in Healthcare

February 6, 2017/7535 views / 0 Comments/in BLOG, Data Integrity, Events/Conferences, Health Care, Patient Identification, Patient Matching, Patient Safety, Podcasts, Revenue Cycle Management /by John Trader

Joe Lavelle with IntrepidNow Healthcare recently interviewed our Co-Founder Michael Trader to discuss the current state of patient identification in healthcare. (Photo re-used with permission from IntrepidNow Healthcare.)

Our thanks to Joe Lavelle and his staff at IntrepidNow Healthcare for the opportunity to appear on his podcast to discuss the current state of identifying the right patient in healthcare. Although accurate identification in healthcare to determine the right patient at all points along the care continuum continues to surge as a focal point for organizations to increase patient safety and improve data integrity, there is still a lot of unanswered questions about how to develop and implement an industry wide solution that has the ubiquity and scale for use by everyone.

Additional topics covered during the podcast include:

The importance of establishing remote patient identification for touchpoints along the care continuum beyond in-person visits such as patient portals, connected health apps, home health visits, telemedicine, and more.
Why establishing a holistic patient identification strategy is now required in healthcare.
Details on the RightPatient® cloud software-as-a-service (SaaS) platform.
Why photo biometrics is hands down the most effective, secure, flexible, scalable, and hygienic solution to determine the right patient in healthcare.
Updates on CHIME’s national patient ID contest.
What additional elements are needed to advance discussion of accurate patient identification in healthcare to a congressional level.
RightPatient®’s plans for the upcoming HIMSS conference in Orlando.

As we approach the annual HIMSS conference, it’s important to continue dialogue and advancing initiatives that show promise to resolving the patient identification crisis in healthcare. Identifying the right patient at the outset of each encounter with the healthcare system ensures the success for many other downstream activities and is the only true way to improve and maintain data integrity — the true linchpin for interoperability and health information exchange.

We invite you to visit RightPatient® in the GA Health IT Pavilion, Booth #3015 at the HIMSS conference to see firsthand how adding cognitive vision to a healthcare technology ecosystem improves revenue cycle management and secures a patient portal, among many other uses.

Here is our Co-Founder Michael Trader’s conversation with Joe Lavelle from IntrepidNow Healthcare:

Thank you again to Joe Lavelle and his staff for this opportunity!

5 Big Indicators You Should Replace Your Revenue Cycle Management Solution

February 11, 2016/4335 views / 0 Comments/in BLOG, Guest Blog Posts, Revenue Cycle Management /by John Trader

The following guest post was submitted by Eugenia Lin.

If you saw a friend using a computer still running on Windows XP, your immediate reaction would be to ask why they haven’t updated to a newer operating system. XP is now 15 years old and Microsoft no longer provides technical support or security updates for it. Unless they really enjoy playing Solitaire and putting their data at risk, then there’s no excuse for having outdated software. The same reasoning applies to your revenue cycle management (RCM) system. Having an updated RCM solution will not only empower your staff, but also benefit your financial bottom line. Here are a few indicators that your RCM software needs updating:

What are some obvious signs that you need to upgrade your revenue cycle management (RCM) system?

1. Lack of business intelligence (BI) reporting and analytics
BI reporting is an incredibly powerful tool that allows one to obtain insights and identify trends on both a macro and micro level. For example, through macro level reporting a practice’s overall profitability can be reviewed. Then through the same interface, the data can be segmented further down to the profitability of all offered procedures. Easily accessing such information in a self-service manner not only shortens the decision making process but also excludes the need for outside consulting parties.

2. Unable to manage a growing or a multi-clinic practice
If your RCM system isn’t scalable or doesn’t offer customization for medical specialties, then it is time to look for another solution. There are systems available that are able to manage a solo provider, a multi-clinic practice, and anything in between. The benefit of this, is that a business manager can oversee and administer at any level easily.

3. Fails to manage and facilitate the entire claims process
It is essential that your RCM system be capable of managing the claims process from start to finish. Starting with claims from scrubbing to prevent coding errors and typos, as human error is one of the most common causes for payment denial. Your RCM system should also provide snapshot reporting, allowing you to monitor outstanding claims and categorizing them by where in the process they are. It should also provide alerts on claims that need following up on, so that none fall through the cracks.

4. Doesn’t fit into current workflow
Another clue that your RCM solution needs replacing is when it’s impeding your practice’s efficiency. Current RCM systems contain tools and features that improve workflow and staff productivity. RCMs can instantly verify insurance eligibility directly through the user interface, allowing your staff to focus on other tasks and avoid wasting time navigating through an insurance provider’s automated phone system. They can also easily manage payment reminders and follow-ups through automated texts or emails.

5. Doesn’t provide important features or cannot integrate with other systems
Having an RCM system able to seamlessly cooperate with your practice’s other system can be greatly beneficial. For instance, when integrated with an EHR system, the claims process becomes even more automated and less prone to errors. As forms can be auto filled with data from a patient’s file, versus a staff member having to manually fill the forms while referring to a paper chart or a separate note taking system.

Eugenia Lin avidly enjoys writing about a variety of topics and currently writes on behalf of the revenue cycle management experts at OmniMD. When not writing, she can be found spoiling her pet, Yeti, with treats or trying to be active outside on those typical Seattle rainy days. You can find her at LinkedIn.