5 Proven Ways to Improve Healthcare RCM

Every hospital wishes to improve revenue, but the challenges of declining or static patient volumes, reductions in reimbursement rates, and the reclassification of patient cases cause a major hindrance. 

RCM efforts after the patient arrives (billing, coding, collections) have typically garnered the most investments historically, but sustainable improvements have been found lacking. The majority of underpayments, denials, and audits are linked to the inability to comply with authorization on the front-end of the RCM process (i.e. prior to the clinical encounter). 

Hence, hospitals should choose to focus on these 5 proven methods to improve healthcare RCM:


  • Help make is easy for patients to complete payments:


Healthcare practices need to set expectations and make them clear from the very beginning. They should check whether it is possible to contact patients to confirm how much the owe and when they are able to pay prior to the scheduled appointment. Other options would be to collect payments through the phone or even keeping their credit card on file. For patients who have trouble paying off their entire bill at one go, you may even figure out a payment plan or provide other financing options. It is wise to note that being paid consistently a little bit at a time is far better than being paid nothing at all. One other effective option would be to provide a payment portal online for easier access. 


  • Eradicate front-end and back-end silos:


Knowledge gaps occur when front-end staff that deal with patients directly and back-end staff that deal with coding and billing are completely segmented.  When these 2 staff are completely synced, knowledge gaps can be eliminated, which leads to efficient claims processing. In fact, having registration staff, centralized schedulers, and billers teach their colleagues about their job has been proven to increase point-of-service collections from patients by a very significant margin. By bringing efficiency into all these processes, you can have enhanced healthcare RCM. 


  • Track KPIs:


Have a clear document containing KPIs such as net days in AR, claims denial rates, cash collection and final denial write-offs based off a percentage of patient services revenues, and their cost to collect. These indicators reflect how efficiently and accurately staff are performing their tasks. More importantly, they show whether the trend line is headed in the right direction. If it is headed in the opposite direction, however, you can now consider spending time in figuring out how to manage your resources and workforce better in the future.


  • Automate eligibility and prior authorizations:


Providers are increasingly facing greater demands when it comes to prior authorizations. This is not only a hassle, but an avoidable expense as well. However, these authorizations can cut down the time it takes to process every transaction and can also help in reducing costs as well. 


  • Have a dedicated and proficient care coordinator:


A care coordinator can make a massive difference to your hospital operations. They can help facilitate the transition to reimbursements that are value-based by keeping abreast of policy and legislation changes. They can also serve as a liaison between providers and patients and encourage patients to be more responsible and compliant. Finally, they can also help organize and initiate health and wellness initiatives. All these efforts can help a healthcare provider benefit from higher reimbursements and improved health outcomes. 

Healthcare RCM has several facets and improving it requires substantial changes. However, implementing the above-mentioned measures will enable you to improve your healthcare RCM.