6 ways to streamline RCM processes

Medical practices are always looking for ways to maximize patient care. To achieve this, there are various strategies physicians can use to streamline revenue-related processes, according to the American Medical Association.

The AMA said it's important that physicians have a practice management system in place that works best for staff and medical personnel before implementing new processes.

Once a PMS is in place, the AMA recommends practices take advantage of these six ways to make revenue cycle management processes more efficient.

1. Verify insurance eligibility electronically before visits. Practices can save time with electronic insurance eligibility verification, according to the AMA. This means scheduling or registration staff collects patient insurance information and submits an electronic eligibility request by entering the patient's data into the PMS.

2. Reduce prior authorization burdens through electronic transactions. The AMA said newly available electronic pharmacy prior authorization transactions allow physicians to finish prior authorization requirements as part of the e-prescribing work flow. They said physicians should identify their e-prescribing system vendor's time frame and request this new technology for their practice.

3. Submit claims electronically to save time and money. Practices can save time and speed up health plan adjudication and payment by submitting healthcare claims electronically, according to the AMA. The AMA said after a practice's PMS generates an electronic claim, the practice can either submit it directly to the health plan or indirectly through a clearinghouse or billing service, which may pre-audit or "scrub" claims before submitting them to check for missing or incorrect information.

4. Determine the status of a submitted claim. The AMA recommends practices use an electronic claim status inquiry to confirm receipt and determine status of submitted claims. The group said practices can send "batch" transmissions to health plans to check the status of multiple claims at the same time.

5. Use electronic remittance advice to simplify processing of payment information. The standardized ERA, an electronic version of a paper explanation of benefits, can more quickly identify claims that require reworking and save time for staff to spend on higher-value activities, according to the AMA. The group recommends engaging all involved trading partners, including health plans, the practice's PMS vendor and any billing service that the practice uses when implementing ERA.

6. Maximize collection of patient payment. The rising popularity of high deductible health plans is shaking the financial cornerstones of the healthcare industry, and everyone's pocketbooks are feeling the impact. For practices, collecting payments while the patient is still in theoffice is a vital first step in any effective patient collections strategy, according to the AMA. The AMA recommends practices completing an electronic eligibility check to get information about the patient cost, and then use this information, along with the health plan's current fee schedule, to calculate the amount the patient owes.

 

 

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