In this article we are going to discuss about RCM Strategies for Small and Rural Hospitals.
nRural hospital leadership and management teams with generally accepted best practice concepts in revenue cycle management to consider performance improvement opportunities within their hospitals and individual departments. It is also designed to help State Rural Health Office Directors and Flex Program Coordinators better understand revenue cycle best practices so they can develop educational training to further assist rural hospitals in improving performance. The Tennessee Rural Hospital Patient Safety Demonstration Project pursues improving patient safety in small rural facilities by strengthening their capacity to implement priority patient safety interventions. nnThe project focused on interventions relevant to the basic services and capacities of rural hospitals and was sensitive to their structure and processes. A process was developed to assess the status of hospital patient safety programs and provide technical assistance tools and resources. Organisational and clinical changes aimed at preventing errors and increasing safety were initiated. Eight participating hospitals completed a self-assessment tool to identify and prioritise patient safety in rural hospitals. These hospitals implemented three interventions: patient safety culture assessment and implementation of a safety culture plan, development and implementation of emergency department protocols, and use of personal digital assistants (PDAs) by physicians at the point of care to reduce medication errors.n
Why Does Revenue Cycle Management Matters?
nFew industries face the complexity of healthcare in terms of revenue. Every step of the process—from patient registration to coding services provided to invoicing and finally collecting payments—is subject to complex government regulations and insurance procedures. This is why revenue cycle management (RCM) has become a specialised and critical part of the healthcare industry.n
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nFor a small healthcare provider, staying on top of things like insurance coverage, healthcare billing, and patient payments is a burden. There’s a lot that can go wrong that can prevent timely payments — such as incorrect coding and a lack of up-to-date knowledge of insurance company claims procedures. This is why it is increasingly common to outsource some of these administrative aspects of medical services to healthcare revenue cycle management companies.nnLarger healthcare organisations have more capacity to operate both administrative and clinical functions in-house. The ever-increasing complexity of healthcare systems means they face constant pressure to improve systems and efficiency, whether that means adopting new software systems, outsourcing RCM components, or both. Properly managing the revenue cycle can make a huge difference in the bottom line for any healthcare organisation.nnAlso Read:n
Successful RCM Strategies for Rural Hospitals
nFocusing on reducing your gross daily revenue (GDRO) will improve cash flow, giving you the predictable revenue your rural or critical care hospital needs.n
Reducing Operational Costs:
nRejection staffing fundamentally increases costs and reduces revenue. Moving from the status quo to continuous process improvement will lower your operating costs and allow your rural hospital to operate more efficiently.n
nThe adage “What gets measured gets improved” applies equally to healthcare revenue cycle management. For example, you can measure the percentage of net claims. You should see patterns emerge, and find ways to improve your process to shorten the days between service rendered and payment.n
By these RCM strategies we can grow our hospitals.
Automate Prior Authorizations and Eligibility:
nVerifying insurance coverage at patient registration is the first step to a successful RCM. Insurance companies are increasingly creating stricter requirements for prior authorization and coverage eligibility. This increase in claims necessarily slows reimbursement and can result in many more denied claims. Automating prior authorization and eligibility can help optimise clinical processes, accelerate the revenue cycle, and reduce the time spent on this task for front office staff.n
nRural hospitals that practise denial elimination are more effective at managing a successful revenue cycle. Each denied claim costs the rural hospital $25. Reporting a rejection is time-consuming, wastes valuable resources, and does not resolve the problem that caused the rejection. Preventing denials by monitoring trends and patterns is the only way to ensure your claims are paid quickly.n
Timely Filing of Claims:
nMany healthcare organisations do not file claims on time and miss filing deadlines. Medicare allows one year for filing claims from the date of service, but many private insurance companies only allow 90 days. If deadlines are not met, claims remain unpaid and the practice must write off clinical services. It is important to have processes in place to ensure these deadlines are met.n
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How can an RCM Help the Rural Healthcare System?
- One of the great things about rural health care is that because the community is smaller, there is a good chance that patients and medical providers have been friends for years. Perhaps the doctor regularly visits the bakery owned by her patient or has a patient who is also her child’s third-grade teacher.
- But this can certainly have a downside, as office staff may feel uncomfortable having to call and contact friends in their community about late patient payments or problems caused by a healthcare provider not getting paid. That’s where an extended business office provider can handle those awkward calls and work toward a positive solution that doesn’t threaten personal relationships.nn
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- Rural healthcare systems may also have limited technological resources or struggle to recruit office staff with expertise in the confusing, ever-changing world of insurance and patient payments. A revenue cycle management provider like Assistants LLC is up-to-date on insurance nuances and is prepared to share that information with patients in a way that is easy to understand. The Assistant’s entire business is medical billing, so she can provide professional services, while it can be more challenging for hospital staff.
- In addition, medical extended business office companies can reduce the costs associated with hiring in-house staff to handle medical billing. They can also free up your existing employees to focus on other tasks or projects that can also increase revenue. Instead of being on the phone all day trying to explain confusing medical statements to patients, they can greet patients, schedule, run medical charts, assist medical staff, and more.
Hope you have learned all about RCM Strategies for Small and Rural Hospitals.
nIn healthcare, revenue cycle management (RCM) is the procedure used to track and collect revenue from patients. RCM begins with scheduling a patient for a clinical encounter through final payment for medical services rendered. RCM is not a maintenance strategy, but a quality management process from which a world-class maintenance strategy is derived based on the application of the RCM analysis process to system and equipment functions.