5 pieces of RCM advice for physician practices

As reimbursement models become more focused on patient outcomes rather than volume, it is even more critical physician practices manage revenue cycle management efficiently to protect earnings.

To do this, practices need to keep an eye on a number of trends driving RCM, according to Ken Bradley, vice president of strategic planning and regulatory compliance at Navicure, a Duluth, Ga.-based claims clearinghouse and RCM vendor. These trends include technology innovations and updates, consumerism, process improvements, the shift to value-based care and data analytics.

Here, Mr. Bradley provides five steps practices can take to stay on top of the trends.

1. Automate processes. Mr. Bradley recommends eliminating manual processes and moving toward automation. This may involve using advanced analytics to see why claims are denied, for instance. As a result, providers will "probably be more effective with collecting revenue from payers and patients, and it'll give them more time to focus on retooling their practice for a value-based world, so they can start thinking of new technology new advanced population health tools," he says.

2. Work with partners. Mr. Bradley recommends working with payers, clearing houses, vendors and other partners to streamline current fee-for-service models. These efforts are designed to improve accounts receivable, lower operating costs and improve collection efforts.

3. Build on fee-for-service step-by-step. Practices should start with pay-for performance then subsequently migrate into bundles and eventually shared savings and risk, according to Mr. Bradley. He says practices should only move into the next reimbursement model as they master the skills of the stage prior.

4. Use key performance indicators. This means having data tools in place that provide real-time information to all practice members, according to Mr. Bradley. For instance, the tools should display the practice's current costs per patient encounter and the practice's revenue per patient encounter, broken down by payer. This helps ensure the practice doesn't "fall victim to, 'We thought we were going the right way [with decisions], but we really weren't,'" he says. "I think that's why getting that new culture of driving the operations of the practice through key performance indicators is a key way to move into the future."

5. Help patients understand their insurance coverage and out-of-pocket costs. Mr. Bradley says practices should make it easy for patients to pay, particularly as the patient revenue stream becomes more significant. Therefore, he argues physician groups must implement best practices such as collecting at the time of service, providing estimates and having credit cards on file. He added, "Chasing those dollars after patient leaves is becoming an old-fashioned idea because the revenue stream needs to have more certainty."


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