Do you have the right gear in your RCM backpack?

Whether you’re up in the mountains or lounging on the beach, summer is a great time to travel. When planning a trip, having all the right essentials packed is important to ensure you have a pleasant journey.

Likewise, when it comes to your days in AR, having the proper tools is the best way to deliver favorable revenue cycle results, especially when it comes to your back-end processes. Implementing smart AR interventions, combined with packing some of the key items in your “RCM backpack,” are the best ways to create a successful revenue cycle management journey and program.

Here are three things to consider.

1. Before you begin, empty your backpack. When going hiking, it’s good to check through the items in your pack rather than assuming your compass, emergency batteries and trail mix are good to go. Similarly, reviewing the current state of your AR performance and key performance indicators (KPIs) is important—and can influence outcomes. Ideally, these include metrics within best practice ranges of the following:

  • Days outstanding at <30 days
  • AR over 90 days at <20%
  • Claim denial rate of <5%
  • Claim submission speed 95% within 5 days of procedure
  • Clean claim rate of 98%
  • Net collection rate of >97%

Chances are you have room for improvement as do many organizations. In that case, these KPIs can serve as your compass.

2. Map your direction accurately. These days, GPS makes it easy to stay on the right route; it’s all about having a map with the most accurate, up-to-date information. Similarly, you’ll need accurate data to manage the billing journey—and help patients manage theirs, especially as they acquire more financial responsibility. Key data includes:

  • What is the breakdown of billing costs? What will insurance pay and what will the patient owe?
  • Is there hidden insurance patients don’t know about or haven’t told you about?

This information can help you get paid faster and ensure you haven’t left any revenue on the table.

3. Step up your approach to denial management. Whether you’re on the beach or a mountain trail, you can better manage the terrain in the right footwear. For your revenue cycle, you can step up your approach with a) claims management and monitoring tools that simplify claims submission b) information that helps you get paid faster. For the latter, make sure you know:

  • Can you see where each claim is as it moves through the entire adjudication process?
  • How quickly can your staff work denials?

There’s more insight to help make sure you’re geared up properly for your revenue cycle challenges in our ebook AR Checkup: The Providers’ Guide to Healthy Accounts Receivable.


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