Revenue cycle management success: Learn these key factors

Your ophthalmic practice should be leaning heavily on its revenue cycle management plan. RCM can help your practice minimize errors, increase the chances you will get paid, and tamp down on the size of your accounts receivable.

Managing revenue is necessary, of course, for keeping the lights on and the employees paid, but enacting a sound RCM policy can be more complicated than it sounds. Partnering with the right RCM provider will go a long way to ensuring your ophthalmic practice can solve billing issues and engage in sound healthcare revenue collection and data protection.

This blog investigates revenue cycle management and details the key factors behind RCM success.

What is revenue cycle management?

Revenue cycle management (RCM) is the process of handling billing, payment, and processing. It begins each time a bill is sent out to a customer and follows through to the payment collection or bill write-off process. In healthcare, where insurance providers may pay on their own schedule and patients can take weeks or more to pay bills, this process is complex and influenced by a variety of factors.

In optical practices, RCM uses practices and tools to keep this process smooth and orderly while also bringing in as much revenue as the practice is entitled to and doing so as quickly as possible. Simply put, a good revenue cycle management plan will ensure your practice has a reliable, predictable, and steady influx of cash in order to support operations.

What are the components of revenue cycle management?

A complete revenue cycle management process for eye care providers or really any other health care provider includes a number of key steps. Those are:

  • Claims preparation: This step begins before the claim is submitted; it can happen before the appointment, while the patient is checking in, or even if need be while the patient is in the exam room. First, the patient’s information is collected, and then the patient’s eligibility and insurance coverage are determined and verified.
  • Claims submission: In this step, the actual claim is created, the codes are determined, and the charges are entered. After a double-check, the claim is submitted to the patient’s insurance provider.
  • Claims management: This step includes the management of the claim, including tracking its progress and handling any queries from relevant parties.
  • Receivables collection: During this step, statements are created and sent, and money is collected from the patient to satisfy any amount due in addition to what insurance is handling. If collections is required, it would happen during this step.
  • Analysis and evaluation: During this final step, the billing team collects and prepares for analysis any metrics associated with the claim for future tracking and analysis.

What are the benefits of revenue cycle management?

RCM in optometry practices is important because it smooths and speeds the payment process – done right, you get more money coming into your account, and it arrives in predictable and dependable ways.

Some industries have it easy – in retail, you set an item out for sale, then someone buys it, agrees to the price on the price tag, and hands you their cash or credit card; the transaction is handled in a matter of minutes, if not less. But in health care, physician revenue is a complex process, and in part because of this complexity, there is a high chance of seeing errors, mistakes, confusion, and protracted back and forth communication with a variety of parties and stakeholders.

An effective RCM process will cut through much of this clutter, reduce the number of errors in the claims and billing process, and shorten the payment process. If there are errors after you have implemented a sound RCM process, they in general will be much simpler to solve.

Key factors in an RCM process

Ready to learn about the key factors in the RCM process?

  1. Get buy-in from leadership: Your organization may have done things a certain way for years – and be used to it and comfortable with it. To get the maximum advantage from your revenue cycle management, make sure that everyone in your organization, from leadership on down, is on board and fully supportive.
  2. Be careful with implementation: If RCM is new at your practice, a full-scale implementation may throw your staff for a loop. Before beginning, follow the implementation advice from your RCM partner, who may suggest a staggered approach that included ongoing support and user training and evolution.
  3. Know how to use your data: Data is a key output from your RCM process. The accumulation of these data can be a valuable tool as you seek to refine processes, segment markets, and target services. The right RCM partner can help you put your data to beneficial use.
  4. Find the right partner: RCM is not just like buying a software package and logging into it. Implementation of a revenue cycle management process will mean you need to work closely with your RCM partner. Do you trust them? Are they empathetic leaders? Are they invested in your success? Do they bring value to your project? Do they have extensive industry knowledge? You will be in it for the long haul with your RCM partner – do your best to make sure it is a relationship you want to be engaged in.
  5. Make sure you have the right technology: Hand in hand with finding the right RCM partner is having an RCM system that has the right technology to get done what you want to get done. This means solutions that are specific to your practice, that solve your verification and receivables problems, and that will adapt to changing needs.

Find the right partner for your RCM implementation

Is your RCM provider a true partner who is invested in your success? Eye Care Leaders has advanced RCM solutions designed specifically for eye care providers. These tools are designed to optimize tasks important to your office’s success such as pre-registrations, insurance verification, authorization, payment, billing, and collections. All are designed to ensure your continued profitability while also supporting enhanced patient satisfaction.

Eye Care Leaders provides RCM services under its myCare line of solutions, which also includes MIPS assurance, HIPAA compliance, patient reactivation, and patient acquisition and retention.

To learn more about RCM contact Eye Care Leaders today.

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