Revenue Cycle Management
Revenue Cycle Management: The Key to Meeting Today’s Challenges
Considering the current regulatory environment and increases in ADR’S, RAC audits, and denials, most home healthcare processes and systems fall far short of meeting present-day challenges. To address these pressing issues, mere automation is insufficient. Quality processes are required more than at any other time. In order to be compliant in the contemporary regulatory environment, home healthcare providers must employ more than just point-of-care technology and centralized billing/coding. It is imperative to utilize the Revenue Cycle Management processes to verify, review, and reconcile data as part of compliant revenue generation. Incorporating Revenue Cycle Management as part of an overall business strategy often results in improved reimbursement, billing compliance, and clinical outcomes. Lost revenue and poor compliance go hand in hand. OASIS and coding errors often are the result of incomplete and incongruent assessments. Billing mistakes typically occur because visit activities can vary from physician orders, while data errors frequently are triggered by hurried keying into point-of-care and EMR systems. A well-developed Revenue Cycle Management system as part of operations, implemented in real time, can mitigate most of these costly mistakes.
What is Revenue Cycle Management?
Healthcare is rapidly evolving. Payment systems, care protocols, clinical and documentation rules, and the hundreds of other elements are transforming at lightning speed. In order to maintain peak operational efficiency and profitability in the midst of these sweeping changes, providers must have access to the most up-to-date tools and processes. Revenue Cycle Management provides these indispensable components. Revenue Cycle Management or RCM is a complete data capture and error mitigation philosophy impacting virtually every aspect of a healthcare provider’s business operations. This includes accurate patient assessment, correct OASIS, clean patient data, physician order monitoring, visit reconciliation, clinical coding with review, QI oversight, A/R management and collections follow-up. Systems must be designed into processes that identify errors prior to revenue generation. Catching up with after-the-fact chart audits is not adequate in today’s environment. Operations must have built-in processes that catch incongruence’s in real time while they are occurring…not after the bill has flown out the door. RCM systems monitor all administrative and clinical components that contribute to the capture, management, and collection of patient service data. The heart of the RCM process is a team of specialists charged with the responsibility of establishing and implementing revenue cycle policies, procedures, and performance measures and standards.
Primary Advantages of Revenue Cycle Management for Home Healthcare Providers
Hospitals and other major medical entities have been utilizing Revenue Cycle Management to enhance their efficiency and financial performance for years. The time has arrived for home healthcare providers to profit from the numerous advantages that Revenue Cycle Management delivers. The foundation of RCM effectiveness is expertise. Revenue Cycle Management offers agencies the distinct advantage of personal, hands-on involvement provided by teams of knowledgeable specialists. By scrupulously overseeing every step of the revenue generation process, RCM specialists deliver the highest results in both the revenue and compliance areas. The RCM edge is evident from the very beginning during the billing process. Assisted by a complete array of sophisticated technological tools, Revenue Cycle Management processes ensure all charges for patient services are captured, edited, and finally entered into the appropriate system for proper billing. In addition, the involvement of these specialists greatly reduces the amount of time from point of service to billing entry. This eliminates the all-too-familiar scenario of lags in entering this critical information, which often results in exasperating billing and revenue collection delays. Revenue Cycle Management ensures that the gamut of other processes involved in the revenue stream are overseen with equal meticulousness. Insurance verification, audits, accounts receivable, and all other vital elements are in effect put under a high powered microscope. When something is amiss, revenue-enhancing adjustments are duly recommended and implemented. While providing resources targeting profitability, Revenue Cycle Management also focuses on compliance fulfillment. At this level, coding accuracy is indispensable. For the average home healthcare agency, however, achieving the necessary level of accuracy on a consistent basis typically is an impossible dream. Among the most prominent roadblocks to coding success is the speed with which codes change. Dozens of alterations take place each year, seemingly in the blink of an eye. Coding errors create even further challenges. The majority of the challenges are related to the accuracy and completeness of documentation. Co-morbities as well as manifestation codes are missed during this phase, permitting improper sequencing and inaccurate primary diagnoses. Clearly, the process must begin with an accurate assessment. A crucial component of this phase is assembling the tools that properly channel the critical thinking skills required of the field staff. Revenue Cycle Management provides agencies with the clear-cut advantage of coding specialists. These knowledgeable experts employ sophisticated methods to cut through the swath of coding complexities that agencies face on a daily basis. Under their scrupulous attention, all coding input is meticulously monitored and, if necessary, corrected to ensure complete compliance fulfillment. Given the sheer volume of coding inaccuracies that can occur, expert management of this area is critical.
Focus on the Future
Revenue Cycle Management is not limited to monitoring and modifying present performance. The system also provides resources for determining an agency’s future path. Utilizing sophisticated metrics, RCM process can gauge an agency’s current performance level to determine strengths and weaknesses. With a baseline performance established, feasible goals are set and appropriate changes implemented. RCM employs a wealth of metric tools to monitor progress toward all specified goals. Throughout the progression period, agencies are provided with recommendations intended to facilitate goal attainment.
Time Bonus
A byproduct of implementing Revenue Cycle Management can best be described as a Time Bonus. While Revenue Cycle Management supports the process of navigating the twists and turns of the business terrain, agencies gain a dramatic increase in available time to focus on their priority – patient care. The inevitable upside to agencies, of course, is improved service, and very likely, a growing client base.
Clearly, effective Revenue Cycle Management is a timely solution providing agencies with a foundation for a vigorous bottom line, a solid grip on financial activities, freedom to focus on priorities, and a welcome relief from compliance anxiety.