Revenue Cycle Basics Every Eye Care Leader Should Know

What do you associate with the acronym, “RCM?” Overused? Everyone and everything does it? If you’re like most healthcare professionals you’ve heard the term a lot without much clarity. You may even be paying for RCM without knowing exactly what it is.

The ABCs of RCS

If your head spins when you hear terms like revenue cycle management, revenue cycle, revenue cycle services, and finally, revenue cycle management services, you’re not alone. I find that many eye care providers use these terms interchangeably. But there are clear differences, and knowing them will help you cut through the jargon and focus on improving your practice’s financial strength:

  • Revenue Cycle: The HFMA describes it as “All administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue.” In other words, the entire life cycle of a patient account, from creation till the account balance is zero.
  • Revenue Cycle Management (RCM): The processes that help a practice manage its revenue cycle. RCM includes software and tools, often from multiple vendors.
  • Revenue Cycle Services: Services provided by third-party companies, usually using the practice’s own software. Services include assistance with accounts receivable, claims processing, and billing.
  • Revenue Cycle Solution (RCS): An all-in-one option combining RCM and servicesplus the software, tools, and expertise you need for complete revenue optimization. RCS lets you hand off day-to-day administrative tasks so you can focus on making more money by providing quality care and growing your practice.

A new approach combining software and services is revolutionizing the revenue cycle. It’s called RCS, and using this approach could solidify your practice’s financial health right now, and down the road.

When DIY Means Money Down the Drain

“The revenue cycle is incredibly complex. There are more than eight basic steps, each with their own sub-steps and workflows,” relays Yadvinder Singh Jaspal, president of Revenue Health Solutions, LLC. “Every practice defines the components differently.”All too often, this complexity results in missed revenue opportunities for physicians.

It’s nearly impossible for practice staff to excel in each and every aspect of revenue cycle management. From patient scheduling and insurance verification to coding, claims scrubbing, and collections, staff are incredibly constrained as to how much time and training they have. As a consultant, I always find something, and usually several things, that can be optimized in every practice I visit. I routinely see practices leaving thousands of dollars on the table every month, through both long term, systemic problems and short term breaks incash flow.

Software Won’t Save You

Practice management software and EHRs promised to save time and make running a practice easier—but the systems can’t magically fix the data that clinicians and staff input. “Garbage in, garbage out,” has never been truer, and traditional billing companies that use a practice’s own software can only perform as well as the “garbage in.” Revenue cycle services or third-party billing companies can only work with the charges that your practice provides. If your practice has poor workflow, noncompliant processes, or improper charge capturing, your financial performance will still be weak. More recently, a new approach combining software and services is revolutionizing the revenue cycle. It’s called RCS, and using this approach could solidify your practice’s financial health right now, and down the road.

RCS: The Best of Both Worlds

Working with multiple vendors is a hassle, especially when it comes to optimizing and streamlining your revenue cycle. It can also leave gaps in tools or services where your hard-earned revenue can leak away. But when a practice has its systems and services provided by a single RCS vendor, something magical happens: you’ll gain insight into how your practice can be more efficient, compliant, and profitable throughout the revenue cycle, from start to finish.

“The right vendor will up the ante with in-depth eye care knowledge and RCS experts who can reveal opportunities to improve your practice’s key financial metrics” says Eye Care Leaders’ Vice President of RCS Programs Jennifer Godreau, CPC, CPMA, CPEDC, AHIMA Approved ICD-10-CM/PCS Trainer. “We’ve transitioned practices from poor revenue performers with high risk to eye care industry profit leaders with very low risk”

How can you put RCS to work for your practice? Stay tuned to find out the top ten areas where your revenue cycle is failing, and how RCS can help.

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