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What is Revenue Cycle Management in Healthcare?

What is Revenue Cycle Management in Healthcare?

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Your practice helps your patients stay healthy, but are you looking out for your financial health? Revenue cycle management is the process your practice uses to keep track of your coding, billing, accounts receivable, and revenue. A strong revenue cycle management approach will help you get paid faster and reduce denied claims, saving you time and money. Here are the key tasks in medical billing that define revenue cycle management.

Revenue Cycle Management: Patient Registration

Medical billing starts with accurate, up-to-date patient information. You cannot bill patients’ insurance with inaccurate coverage information. Your practice needs processes to ensure that crucial patient information, such as insurance coverage and patient contact information, is regularly reviewed and updated. Practice Management and EHR systems, like NextGen, can be optimized to improve the accuracy of your patient information. For example, with the NextGen Patient Portal (formerly Medfusion), you can prompt patients to verify personal information and insurance coverage during check-in. Through the use of the Background Business Processor (BBP) and RTS you can automate insurance eligibility checking days prior to the patient coming in for an appointment. If the patient is ineligible, you have time to fix the insurance before the visit and prior to a claim ever being created.

Revenue Cycle Management: Coding

Payers reimburse your practice based on the diagnoses and procedures that you bill. Accurate procedure and diagnosis coding ensure that you get paid in full and on time. Your EHR and EPM system can help your providers complete coding and documentation tasks during visits. This approach saves time and improves coding accuracy. Built-in tools can flag potential missing diagnoses and help medical billing specialists fix dirty claims before they ever make it to the clearinghouse.

Tools like RCxRules let you configure complex business logic to stop or automatically fix claim issues after the physician codes the encounter. This data can help your practice identify gaps in coding and fix them, oftentimes without manual intervention. TempDev’s Provider Executive Summary shows you provider coding habits, payer mix, and A/R aging so you can target training and workflow interventions to track key revenue cycle bottlenecks.

Revenue Cycle Management: Billing

Your providers complete coding and documentation to allow your practice to bill for the services you provide. For most practices, medical billing specialists handle payer billing. These professionals are experts in billing requirements. They take patient information, coding, and documentation from your EHR system and ensure complete and accurate billing.

With an integrated EHR and practice management billing system, your practice can automate simple billing tasks. For example, your electronic claim files should be automatically created every night and uploaded to your clearinghouse without any biller intervention. This reduces the potential for human error and frees your medical billing specialists to work complex, delayed, or denied claims. By focusing on more complex tasks, your billers can also help identify the causes of denied or delayed claims and develop solutions.

Revenue Cycle Management: Posting

Payment posting is an important part of the revenue cycle. Your medical billing specialists should reconcile payment postings to ensure claims close out timely and with full payment. Partial or delayed payments may require resubmission of claims or phone calls to explore the issue.

Posting should also be done as automated as possible. The posting team should contact every payer to ensure they are receiving ERA files (electronic EOBs) if possible. If ERA files are not possible, contact a company such as MediStreams to convert paper EOBs to ERA files. This frees up your poster's time from manual posting to follow-up and claims denials.

Keeping track of posting will also help your billing department spot denied claims. Claims denials are common, and up to 50 percent of denied claims are never resubmitted. Payers may deny claims for simple typos or other errors, non-covered services, or incomplete coding or documentation. Your medical billing specialists should review and resubmit denied claims. You can also track claims denials in your EHR and EPM system to identify patterns and improve your patient intake, coding, documentation, and billing processes to prevent future denials.

Revenue Cycle Management: Accounts Receivable Follow-Up

Your practice should aim to clear accounts receivable (A/R) within 50 days or less. With tools like TempDev’s Revenue Cycle NextGen EPM Dashboard, you can track A/R aging by payer and identify past-due accounts. Your medical billing specialists can then follow up with late payers to identify the reasons for the delay and improve processes to prevent future delays. You should configure tasking to automatically be created and assigned to your A/R follow-up team so they're consistently contacting payers for status.

Revenue Cycle Management: Credit Balances

Credit balances are overpayments from patients or insurance companies that your practice must reimburse to balance your books. Credit balances in your system could also not actually be credits at all but just a posting error. Credit balances can be caused by billing issues, payer errors, posting issues, or patient overpayments. State laws require patient credit balances to be refunded timely. To comply with state laws and simplify your accounting practices, your practice needs to have processes in place to identify, prioritize, and clear credit balances.

TempDev developed Credit Flow for your NextGen EHR and EPM system to help you track and work credit balances. The Credit Flow suite of tools provides an overview of your credit balances and allows your billing staff to drill down by patient and account to work them and provide refunds. 

Revenue Cycle Management: Reporting

Your revenue cycle also includes financial reporting. From taxes to audits to financial statements, your practice may have a variety of financial reporting requirements. Your revenue cycle management processes will help ensure you have accurate, up-to-date data to complete these year-end reports and requirements. You can also integrate your NextGen EHR with your general ledger system to ease reporting requirements and reduce data duplication. Business intelligence solutions are also commonly implemented with practice management systems to report financial data and trends.

How TempDev Can Help With Revenue Cycle Management

TempDev’s team of NextGen experts can help you streamline all aspects of your revenue cycle, from patient intake to reporting. Reach out today for help optimizing your revenue cycle management processes or add staff augmentation billers with TempBill.

Call us at 888.TEMP.DEV or contact us here for help with revenue cycle management.


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