Admin Top 5 successful Revenue Cycle Management Steps Revenue cycle management is the lifeline of healthcare industry. Just as how the body requires all systems to function properly, each department in RCM cycle also requires a collective, coordinated function. Like, each system of the body supports each other, every department in RCM should help other departments grow, harmonize and be compacted together for a smooth and channeled generation of revenue. Right from Patient Registration to Final payment, every department should be well connected in communication for smooth process flow. In order to reach the level of perfection, obstacles which hinder the growth rate should be identified, to eliminate the common inefficiencies. Analysis methods like “Fish bone technique” help in tracking the reasons for imperfections and aid in identifying the parameters which lower the success rate of RCM. Let us now address the “Top 5 Successful Revenue Cycle Management Steps” to correct few common hurdles in RCM- Common Hurdles of RCM are - Lack of well trained and efficient manpower Employees should be knowledgeable, skilled and updated to contribute to the growth of the company. Lack of training, ends up in stagnant workflow. Keeping the team on track and organized, renders customer satisfaction. A medical facility should take necessary steps to train the employees to be an expertise in their work area for a well-managed and effective work flow. Billing and coding errors Over coding, under coding, billing errors, incomplete and invalid demographic and Insurance data, may lead to claim denials. Coding and billing professionals should be well versed in coding and billing guidelines to avoid unnecessary rejections. Claim rejections and denials Utilizing revenue cycle tools to analyze the gap in rejections and denials is a vital step. Reducing the rejection rates by constantly keeping in line with the coding and billing compliance will boost the overall key performance. Updating the insurance protocols on regular basis Healthcare Insurance laws keeps changing periodically. Validation and constantly updating on regular basis are mandatory to keep in line with current market trends. Revisiting the daily RCM services by checking and validating technological process is necessary. Now let us identify the top 5 steps for a successful RCM flow. Identifying the drawbacks alone is not sufficient but taking necessary actions to enhance and formulate the success parameters of RCM is essential. I have aligned the top 5 Successful steps with the UAE visa process for easy understanding and implementation. Step 1: Patient Registration Process with a Proper Checklist Second step of visa process is to Verification of documents to allow entry or create an entry permit to UAE; similarly, in RCM before submitting a claim for processing, pre-auditing for missing or incorrect information is necessary. Carefully monitoring the billing and coding compliance with the specific insurance standards will increase the percentage of clean claims. This prompts timely processing and payment by the payer. When we work on timely submission, unnecessary delays can be avoided. Step 3: Tracking claims, analyzing reasons, documenting action plans The third step in visa processing is status change. Likewise, a claim undergoes change of status after processing as either a clean claim or rejected claim or denied claim. The medical facility should request a claim transmission status report from the payer to track the accepted, rejected and denied claims. Documenting a denied claim reduces time consumption in handling future claims and increases the efficiency of the team. Always document the reasons for denials, create an action plan and include it in SOP (Standard Operating Procedure) Manual of the department and don’t forget to place the SOP in network folder for whole team to access to avoid such mistakes in future. In many Organizations, the team would be smart and would have handled denials very efficiently but forgets to document in SOP or would have documented but not make it accessible for other team members to get educated. Sharing of knowledge within the team is very essential for any workplace. Many a times our questions would have answers on the same floor but we keep searching the whole world. “Good communication is the bridge between confusion and clarity.” So, Communicate! In brief, keep these parameters in mind- Analyze the reason Increase the Team Efficiency Manage the denial rate So, AIM to reduce denials. Step 4: Creating higher Reimbursement potential Medical fitness test is the fourth step in visa processing which ensures the candidate is medically fit to reside in the country. Similarly, in the health insurance industry, the company should be financially fit showing higher reimbursement rate. Constantly focus on an elevated graph for standard optimization. This is the duty of the denial management team. Once a claim is denied or rejected, this team analyzes the reason and does the necessary correction for resubmission. There should be a gradual rise in reimbursed rate month after month which increases the revenue and boost the company’s market value. This is turn motivated the employees to work better as they feel safe in a financially secured company. Step 5: Implementation of effective technology The final step in visa processing is Visa Stamping - the ultimate endpoint of getting a visa. Create a stamp in the market. Let your employees feel proud in working in such a team and well-established company. Conclusion – “Success is not a destination, it’s a journey” Success in handling one claim or one month claims and showing a good revenue graph is not the end, it’s part of the journey. It’s high time everyone in RCM industry become accountable and work towards the top 5 successful steps to reap the success. In today’s increasingly challenging environment, healthcare services performed utilizing RCM tools, contributes to a new era in RCM industry. By analyzing the gaps and applying the top 5 successful steps, it enriches the Revenue cycle as a whole. Apply “Kaizen theory”- correcting small things leading to major change. It’s an approach of creating continuous improvement in RCM workflow focusing on quality based on small ongoing positive changes in RCM tools to reap major improvements. Remember the “vital trivial theory - 80% of problems are caused by 20% of small issues” hindering the success rate. To bridge this gap, the obstacles hampering the target levels should be clearly identified, analyzed and improved on regular basis to reach the success zone. Successful revenue cycle performance will enrich the financial health and strongly impact Physician’s reimbursement which in turn will improve Quality of care. All the above- mentioned facts are not just the duty of the Healthcare management but also every employee of the RCM. Only if employees understand their importance in creating the change, will the organization realize. “Don’t expect the change- Be the change.”