Improving Revenue Cycle Health: A Definitive Guide

To manage your patients’ health, you also need to manage your revenue cycle health. Your practice depends on timely, accurate reimbursement to keep all aspects of patient care running. If your practice struggles with denied claims, late payments, and delinquent accounts, your revenue cycle health may need a check-up. Here is the definitive guide to improving your revenue cycle health.

Improving Your Revenue Cycle Health Step 1: Get the Right Software and Support

Your practice needs user-friendly software for improving its revenue cycle health. Revenue cycle management tools can help your practice identify, monitor, and correct problems in your revenue cycle. These tools should be integrated with your EHR for maximum efficiency. For example, the NextGen EHR and EPM system include the tools you need to automate physician coding and manage your revenue cycle from within your EHR and EPM system.

Improving your revenue cycle management also requires having the right team. Hiring highly qualified medical billing specialists will ensure you have the right people in place to find and correct problems in your billing processes that can lead to claims denials and delayed payments. Your practice can also outsource or co-source your revenue cycle management to third parties like TempDev. TempDev’s TempBill team can work with your practice to streamline processes, fill in for absences, or augment your medical billing team.

Improving Your Revenue Cycle Health Step 2: Verify Coverage and Eligibility Up Front

Clean medical billing starts with accurate insurance information. You can save your practice many denials by verifying each patient’s insurance coverage and eligibility during appointment check-in. Tools like NextGen Patient Portal (formerly Medfusion) even let patients update and verify their information before arriving in your office. You can also use the Background Business Processor (BBP) to run eligibility using RTS prior to the patient's appointment.

You may also need to collect prior authorization from insurers before performing a procedure or test or prescribing medication for some procedures and specialties. Your EHR and practice management system can help you identify appointments that may require prior authorization and flag them for follow-up. That way, your staff can collect any necessary documentation before the patient arrives for their appointment. Identifying prior authorization needs before office visits saves time by not forcing patients to return later for delayed paperwork. It also helps ensure full reimbursement for the visit.

Improving Your Revenue Cycle Health Step 3: Redesign Your Workflows

Clean medical billing also requires accurate diagnosis and procedure coding during and after visits. If your providers struggle to complete coding during patient visits, your workflows may be to blame. A workflow redesign process helps you align your processes to complete tasks to your goals. So, for example, redesigned patient visit workflows could build in time for EHR data entry, including coding, during patient visits. Entering data during office visits helps ensure data is complete and accurate. It also benefits patients by allowing for instant electronic referrals and e-prescriptions.

Improving Your Revenue Cycle Health Step 4: Automate Billing Where Possible

Manual billing processes are time-consuming and can create errors. EHR systems like NextGen EHR and EPM can help you automate simple billing processes to save time. The NextGen Background Business Processor (BBP) lets you create automated tasks to run overnight without any manual input from medical billing staff. For example, you can set up automated processes to run claims edits against a claims library and flag errors. Your practice can also package and automatically submit electronic claims to your clearinghouse.

Improving Your Revenue Cycle Health Step 5: Track Payment Posting

Revenue cycle health management does not stop at claims submission. Your medical billing staff must also monitor payment posting to ensure accurate, timely payment. Automated processes can help here, too. You can configure your system to download ERA files automatically and import payments and adjustments into your revenue cycle management system. Automating ERA downloading and import processes saves time and helps your medical billing specialists focus on working adjustments and denials.

Revenue Cycle HealthImproving Your Revenue Cycle Health Step 6: Manage Denials

Claims denials are common. Many practices never resubmit denied claims, leaving revenue on the table. Your practice will face claims denials even with strong coding and billing processes. Your medical billing specialists should prioritize working denied claims to ensure timely and accurate resubmission. By verifying insurance information before office visits, fixing coding workflows, and automating billing processes where possible, your practice can ensure your medical billers have the time and resources to prioritize complex tasks like investigating and resubmitting denied claims.

How TempDev Can Help With Revenue Cycle Health Improvement

TempDev’s developers, consultants, and medical billers can help your practice find problems in your revenue cycle and fix them. TempDev can also provide your practice with dashboards and reports to help you keep track of your revenue cycle. If your practice struggles with claim denials, late payments, and delinquent accounts, TempDev can help.

Call us at 888.TEMP.DEV or contact us here to get started improving your revenue cycle health.