Skip to main content

Revenue Cycle Management: The Key to Successful Hospital Medical Billing

December 15, 2022

Efficient and effective revenue cycle management (RCM) is integral to running a profitable facility. Not only does it streamline billing and revenue collection processes to improve your cash flow, but it allows you to continue doing what you do best –providing excellent patient care.

How Revenue Cycle Management Can Improve Patient Care

RCM’s goal of improving profitability and overall financial performance benefits the patient above everyone else. When a facility implements efficient revenue cycle management, it no longer has to spend time and resources on administrative and clinical functions, including correcting billing errors and appealing claims –enabling hospitals to devote more time and money to the quality of patient care they provide.

With a greater focus on patient care, effective hospital medical billing results in the improvement of the overall patient experience. Patients can expect not only a simplified process from scheduling appointments to billing but receive more targeted and comprehensive care that will reduce their likelihood of re-admittance.

coronis health hospital medical workers examining elderly patient

Tips for Improving Each Stage of the Hospital Medical Billing Revenue Cycle

The entire revenue cycle management process is driven by two critical components –time and efficiency of your workflow. 

Optimize the RCM process and help maximize patient collections with the following workflow tips:

  • Empower the front desk to aid the billing process – strengthen the functionality of the front desk in terms of performing crucial tasks that help streamline the billing process. To achieve this, train your staff to perform the following:
    • Accurate data capture – whether the data is collected through a phone call, online booking platform, or the front desk, all details should be accurate and complete (e.g., correct name, mailing address, birth date, and other patient demographics)
    • Double-check eligibility and benefit verifications – check for validity status, modifications in packages from the previous visit, or location changes. With the available information, you can accurately and quickly verify if a treatment will be covered by the existing insurance plan and educate the patient about their benefits.
    • Preauthorize the patient to ensure reimbursement before treatment – the front-end staff can optimize their collections by pre-authorizing claims. It provides a level of guarantee of getting reimbursed for the quality of care provided.
  • Take advantage of technology – technology is the key to streamlining the billing process. Advanced hospital medical billing software and technology enable the use of electronic medical records, automated verification checks and claims scrubbing, and patient self-service features (e.g., digital communication, e-statements, and credit card payments). 
coronis health hospital rcm worker using laptop

Software systems may also suggest correct medical codes and check for insurance payer rules for reimbursement. At its most basic, technology allows for seamless digital transactions and enables various departments to connect and create a more harmonious workflow. By utilizing technology in your clinical and administrative functions, you will save staff hours and avoid errors, denials, and poor collections overall.

  • Improve coding practices – hospital medical billing and coding should be handled by experts to ensure accuracy. Any wrong or missing code leaves you with potentially zero reimbursements. To avoid errors and claim denials:
  • Educate staff on compliance – the healthcare landscape has ever-changing rules and regulations. Arrange for regular staff training to update them on the latest coding practices.
  • Coding audit – to improve your RCM process, schedule regular audits at your facility. Auditing enables you to analyze the entire billing cycle and your payment policies and helps detect coding issues and other inefficiencies affecting your bottom line.
  • Improve clean claims rates – rejected and denied claims will only consume more staff time and slow down cash flow. To generate clean claims, you must:
  • Use scrubbing software to verify claims and identify errors and omissions.
  • Keep track of claims statuses and be prepared for the appeal process. The faster you can shift denied claims to approval-worthy claims, the better for your accounts receivable. 

Common Challenges Hospitals Face in Terms of Medical Billing

There are many reasons why hospitals and other organizations struggle to maintain an efficient RCM workflow, including:

  • Ineffective hospital medical billing process – failure to capture accurate information during patient registration, errors in coding, and declining to verify insurance eligibility can adversely affect your revenue cycle.
  • Manual claims processing – given the complexities around submitting claims and the time and resources required to manage denials, relying on manually-operated tasks not only contributes to administrative burden but increases the risk of errors in billing.
  • Inaccurate coding –with the constant implementation of new rules and regulations, it is no surprise that mistakes can occur during the billing and coding process. The most common errors, no matter how trivial they seem, can lead to claim denials, loss of revenue, fines, and penalties and may even impact patient care. 
  • Lack of staff education and training – when staff members are not properly educated and trained on how their role fits into the overall process, they become more susceptible to performing errors that can cost your facility tens of thousands of dollars a year.
coronis health nurse in a hospital taking patient's blood pressure

How to Overcome These Challenges and Improve Your Hospital’s Bottom Line

To address challenges that impact RCM, hospitals must have a strategic focus on:

  • Clarification of roles and workflow – good revenue cycle management depends upon strong communication. That said, each staff member should know his or her role and how it fits into the overall process of the hospital receiving its payments. Clear role assignments will ensure smarter workflows wherein each and every staff member is aware of their part of the process.
  • Adoption of automated processes – technology can turn manual and mundane tasks into automated processes that generate multiple benefits for many healthcare systems. Hospitals collect and store large amounts of patient data and records daily, and it’s easy for the human eye to get data wrong. 

Automated software will help identify discrepancies and coding errors, provide in-depth audits, reduce workloads, and ensure cleaner claims and compliance.

  • Investing in staff training – to help staff better understand their roles, you must constantly train and educate them on all revenue cycle management practices. Technology won’t work without humans providing the right instructions. 

Applying analytics

Optimizing revenue cycle management relies on focusing on the best industry practices and being committed to continuous improvement. To achieve this focus, hospitals must employ end-to-end revenue cycle analytics by performing comparison analyses.

You may use technology, business intelligence, and AI-powered analytics to identify issues in both internal revenue cycle processes and payer behavior. By measuring the quality of each step of the process, you can use your resources more effectively and make the best business decisions that will positively impact your hospital’s financial standing.

Outsourcing your RCM Services

coronis health hospital healthcare worker taking elderly patient's pulse

Leaving the hospital medical billing services and other administrative functions to the expert professionals spares you from time-consuming tasks and helps you focus on patient care. From pre-authorization, clinical documentation, and coding to collections and denial management, outsourced revenue cycle management can streamline your workflow and ensure the best results. 

Outsourcing also means having access to the latest technology and other resources that will help speed up collections and increase your profitability without compromising privacy rights and compliance.

Questions About Revenue Cycle Management for Your Hospital? Contact an Expert at Coronis Health Today!

Hiring the best revenue cycle management company will provide your facility with countless benefits that include streamlined processes and a consistent payment schedule. You can relieve your facility from undue stress while safeguarding your organization’s revenue into the future. 

At Coronis Health, we provide tailored and flexible solutions to meet the needs of your facility. With more than 35 years of experience in various healthcare niches, including hospitals of all sizes, our experienced consultants understand the importance of working down AR. As technological innovators, we utilize the latest software and employ actionable intelligence so we can assist you in getting your AR under control and, most importantly, get you paid.

Contact Coronis Health to learn more about how our data-driven solutions can help optimize your revenue cycle. You may also request your free financial checkup today.

Get the Latest RCM News Delivered

Receive practical tips on medical billing and breaking news on RCM in your inbox.

Get in Touch