Revenue cycle management in 2024: Achieve clean claims

Do you feel like you’re fighting a constant uphill battle of claim denials in your revenue cycle management? If you answered yes, you’re not alone in your frustration and exhaustion. Like all of your practice’s processes, you want revenue cycle management to be efficient and effective. But how are you supposed to do that when more claims are being returned than ever?

This article will help you:

Maximizing revenue while realistically managing expenses is a challenge for any business. Your practice is no exception. The bad news is there isn’t a quick fix to smooth out your revenue cycle management. The good news is, once you and your staff make some necessary decisions and implement associated strategies, your practice can run more smoothly.

You may have become a physician to provide valuable treatment, help people make better decisions for their own well-being, carry on a family practice or career tradition, develop new treatments, or another reason altogether. 

Whatever your reason, whether you run a small independent practice, work in a collective, or practice within a larger organization, revenue matters to your practice’s longevity. 

Because billing involves many legal and ethical issues, taking a realistic look at your practice’s business model is important. Ask yourself where you want your practice to be in the next 1, 3, and 5 years. What is the best way to keep your practice healthy while fully complying with regulatory requirements? Below is a guide to help you navigate these decisions.

Medical school didn’t prepare you for the business side of healthcare, but it’s not too late to catch up. Part of establishing your revenue goals is to conduct a realistic analysis that considers:

Next, brainstorm how to make that goal. If you feel it’s out of reach, reevaluate. You may need to revise your goal or become more creative about how you plan to meet it.

Considering the business side of your practice doesn’t mean that your patients become numbers and dollar signs — they’re people with unique and individual backgrounds and stories. However, in order to continue to support them, there’s the reality of how you holistically approach running your practice.

You don’t like to receive shocking bills that you didn’t anticipate. Patients don’t either. As a result of the divide between insurance companies that guide in- and out-of-network care, Congress passed the No Surprises Act in January 2020 to improve patient billing transparency.

Trying to stay ahead of the continually changing landscape while keeping up with treatment advancements and growing your practice is enough to bring on burnout. Primary care providers already need 26.7 hours in the workday to keep up. The time management associated with manually managing your practice’s billing would be overwhelming.

Technological advancements have made automated or robotic billing accessible. These processes save you, or your office manager, a significant amount of time and improve your practice’s efficiency while increasing profitability.

These automated processes ensure you use the most accurate codes to safeguard accuracy, maximize revenue, minimize risk, and contribute to your patients’ financial well-being.

The business revenue cycle for your practice involves 3 different areas of the patient lifecycle:

Thinking about how revenue relates to your relationship with your patients may be uncomfortable. Still, the reality is they know there is a fee for your services. Offering as much transparency and information as possible around what their insurance will and won’t cover can empower them to make informed decisions about their care.

Ensure the front office collects active insurance information for each individual when they register as a patient and check in for an appointment. Automated billing processes incorporate relevant patient insurance information with a myriad of billing codes.

Using the technology gives you a picture of what the insurance will and won’t cover as you enter treatment codes. This opens up the opportunity for honest dialogue with your patients.

Understanding the efficiency and effectiveness of your practice is more than anecdotal. It’s essential to have hard data at your fingertips that will provide valuable insight, expose opportunities for improvement, and highlight areas that are going well.

Using technology to find trends by analyzing defined metrics allows you to focus on and prioritize areas you want to change or improve.

Taking advantage of viable technological solutions will make evaluating your practice’s position in your revenue cycle easier. Determine how efficient and effective you and your staff are being so you can ensure happier patients who will have a long-term relationship with you as their provider of choice.