4 Ways Revenue Cycle Management Helps You Monitor Your Financial Vitals

Taking care of our health is one of the cornerstones of life itself. This might mean focusing on physical health by going to the gym, monitoring calorie intake, or getting a physical routine. It could be caring for mental health by practicing meditation, seeing a therapist, or getting outside into nature.

Keeping a finger on the literal and figurative pulse of our well-being is important. This can stretch into our professional lives as we keep our knowledge current, challenge ourselves, and focus on a positive work-life balance.

But what about the financial well-being of your pediatric practice? Are you meeting your goals for patient volume? Are you getting reimbursed properly? While blood pressure and mood are easy to measure, just how do you manage the fiscal health of your practice? Here are four ways to monitor your financial vitals.

1. Understand the Importance of Revenue Cycle Management

In order to identify financial trends and proactively identify billing-related issues, it’s important to understand what the term revenue cycle management (RCM) means. Simply put, revenue equals money. RCM is the process of ensuring your practice gets paid for its services.

When you see a patient, you deserve to be paid for providing that care in a timely manner. It’s a business just like any other company. Even though pediatrics is about taking care of children, you still have to keep the lights on.

2. Realize that RCM Actually Starts at Patient Registration

When you think about RCM, you might assume that the cycle starts after the patient visit, when the claim is generated. But that’s not the right mindset. Even though a claim hasn’t been submitted to a payer, RCM actually begins at patient registration.

When a patient is scheduled, it’s critical that your front office staff has the correct insurance and that eligibility is valid. Make sure that the right payers are on the books. That way — when they check in at your office, everything’s already been verified. Ideally, you get your copay from the patient at the time of service, and then the patient sees the provider.

3. Learn How to Minimize Denials and Get Paid Quickly

Following the patient’s visit, the RCM process picks back up again. You have to ask yourself, “Did we include all charges? Are the proper modifiers entered? Does our RCM service have everything they need?” When the claim goes to the clearinghouse, you want it to pass their edits the first time around and move onto the payer as quickly as possible. One of the benefits of using an RCM service is its quick action to resolve any issues with the clearinghouse rejections.

When the claim gets to the payer, the goal is to get paid within two weeks. However, if the payer denies a claim, it’s critical to have a strong RCM service team jump into action. That team will be laser focused on investigating every unpaid claim, discovering trends, appealing, rebilling and updating your software to minimize future denials. If a claim is denied once, there’s a good chance it will be denied a second time. And if it’s denied a second time, the chances skyrocket that you’ll never get paid. Repeated denied claims is money your office may never see.

Over the years, getting paid has become more and more challenging. It’s critical that you have an RCM service that understands how to avoid and minimize the number of denials so you get paid the first time around, every time.

4. Use Your RCM Dashboard Wisely

With so much data flowing, it’s critical you can look at your practice’s RCM dashboard and easily see a financial overview, especially as it relates to charges, payments, and adjustments. A dashboard should be a quick glance of key performance indicators (KPIs) that showcase the financial health of a practice. For example, you might find you need to focus on denials from a certain insurance company or realize you should work on decreasing days in accounts receivable.

Dashboards help you see high-level information and give you the ability to drill down where you need to. An effective dashboard should be clean and intuitive and provide analytics that are as near to real-time as possible. Just like the machines in the hospital that monitor pulse, blood pressure, and oxygen saturation, your RCM dashboard is giving you critical readings that help you monitor your practice’s financial vitals.

It’s no secret that the pediatric revenue cycle is complex. Keeping up with the constant regulatory changes and payer-specific adjudication rules is nearly impossible. So, why do so many pediatric practices tackle billing in-house versus outsourcing to a reputable specialty-specific billing service? Perhaps it’s because they don’t understand the benefits of outsourced billing.

Check out the guide, The Ultimate Guide on Outsourced Billing for Pediatric Practices, which demystifies outsourced billing and outlines its benefits.

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