The How-to Guide on Improving Your Hospital RCM

Government regulations, changing insurance company contracts and policies, new payment formats, and shifting and evolving patient expectations make hospital revenue cycle management (RCM) more challenging than ever. Hospital healthcare systems need effective methods to meet these increasing demands and manage revenue. Discover how your team can improve hospital RCM from the experienced professionals at Ventra Health.

Strategies for Successful Hospital RCM

The key to maximizing revenue is putting the best management practices in place at your facility. Although no single strategy can completely eliminate RCM challenges, the following techniques can help your team achieve better results:

1. Follow Changes in Regulation

Healthcare revenue cycle laws change frequently at the federal, state, and local levels. Medicare rules and interpretations change at least annually, private payers also modify policies, augmenting the complexity of regulatory compliance. Updating hospital staff on new developments before they are enacted helps ensure RCM teams have ample time to alter protocols. This strategy helps facilities avoid penalties for non-compliance. 

2. Employ Data Analytics 

Without the proper tools in place, it can be extremely difficult to manage revenue cycles and pinpoint areas for improvement. Data analytics uses data reports, charts and graphs to make revenue cycle information easier to digest. Monitoring key performance indicators (KPIs) vs. historical data, trends and benchmarks also plays an important role by providing insights into denials, cycle times and other transactions.

3. Streamline Claims and Denials

Claims submission processes and denials are often challenging for hospital systems to manage. Both governmental and non-governmental payer rules, contracts and requirements change frequently.  Examining claims trends, cycle times and denials data can help improve processes and revenue cycle management as a whole.

4. Review Processes Regularly

Of course, just having data about where your strengths and challenges are does an organization no good if no action is taken on the weak spots.  Given the number of tasks hospitals perform each day, it may seem easier to address RCM problems as they occur and/or where data points you to address. In addition to targeting trouble spots, mapping processes and reviewing them more frequently can ensure that they are updated based on regulatory and procedural changes, changes to hospital policy or strategy and are functioning well. Creating specific cross-functional teams who can respond to common challenges can further support hospital revenue cycle services.

5. Gather the Correct Patient Information 

Hospital front line staff need to navigate difficult data collection processes with many fields and numerous codes on registration forms. Inaccurate or incorrect data captured up front can create delays in processing claims and increase denials.  To avoid reimbursement issues, RCM teams should ensure the information they receive is correct from the start while balancing making the data collection process slow and cumbersome for both registration staff and patients. This simple step can help prevent errors with payments in the future.  Utilizing tools like patient self-check-in in advance through an app or from home can expedite the process while also improving the quality of data captured in advance of service.

6. Value Patient Preferences 

Not all patients appreciate the same form of communication. Some will never use an app or a kiosk to check-in and would prefer to speak to a representative at the hospital when they arrive.  If a hospital sends bills to every person through email, they may not be reaching those who prefer to receive a hard copy in the mail. Asking each patient how they would like to receive statements and other messages can increase satisfaction with the hospital’s service and drive revenue collection and data accuracy.  Keeping processes nimble and current based on trends is also essential as technologies and patient preferences evolve.

7. Educate Patients on Healthcare Costs

More than ever, as healthcare consumerism continues to rise, patients are asking about healthcare costs before agreeing to receive care. This trend stresses the importance of having patient estimate tools in place and for training hospital staff on relaying the estimated expenses of different services and treatments. Staff should also know about any available financial assistance programs that may help to qualify patients if they express concern about the cost of healthcare. This transparency helps ensure more patients feel prepared for upcoming healthcare expenses upon and following discharge.

8. Educate Staff

Updating staff on changes is vital to ensure smoother RCM. Continuing education helps staff members understand how the hospital operates, from entering data in systems to marking discrepancies with processes. Not only can this strategy help enhance hospital revenue cycle management, but it can also boost overall productivity and patient satisfaction.

9. Hire Healthcare Consultants with Expertise in Hospital Revenue Cycle Management

While in-house advancements can substantially boost hospital revenue, it may still be difficult to improve practices on your own. An outside vendor with a fresh perspective, experience at your peer organizations and innovative solutions can be pivotal to enhancing RCM. Businesses like Ventra Health’s Advisory Solutions use data, experience and tools to examine the current processes in place and help healthcare facilities make the best choices for their unique needs.

Receive RCM Consulting Assistance from Ventra Health

Need help?  If your hospital struggles to maintain a consistent revenue cycle, turn to Ventra Health’s Advisory Solutions for comprehensive solutions. We offer numerous advisory and practice administrative services to help hospitals handle a host of RCM challenges, from denials and compliance to coding and physician education. We also utilize analytic tools to help healthcare facilities stimulate revenue. Contact us today to learn more about our hospital revenue cycle consulting services.