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Tending Your RCM Garden

Every gardener knows that a well-tended garden needs to be properly watered, weeded, mulched and fed to bloom and produce desired results. The same is true for your revenue cycle. Neglecting to care for your organization’s bottom line can yield lower success and decreased patient satisfaction.

Here are three ways you can nurture your teams, technology and processes to sow a bountiful harvest.

  1. Tend to your payer contracts. Reviewing and cultivating your payer contracts is an important step in improving your revenue cycle.
    • Review each payer’s prices and the terms of your contracts.
    • Confirm the reimbursement by carefully assessing your remittance data. Data should be available in your claims clearinghouse solution if it enables electronic admittance advice on professional or institutional claims.
    • Compare pricing data by payer and match your analysis with your own cost per procedure code and pull data specific to the payer’s administrative burden to help determine the payer’s “hassle factors.”
    • Make sure you know the current terms in your contracts, including termination, filing deadlines and recoupments.

Use this administrative and clinical data to seek more favorable contracts – that include both better terms and fewer hassles. Check out this blog post for more insights on improving how you work with payers.

  1. Lay a weed barrier to prevent and manage claims denials. Catch problems before they begin with simple steps to decrease claims denials.
    • Train your staff to watch for errors in registration, medical necessity, timely filing, pre-authorizations, duplications, coding and other information.
    • Establish a routine to follow up on all denials within 24 hours.
    • Develop appeal letter templates to simplify your response process.
    • Track and categorize denials by payer and provider so you can jump on new opportunities to make your revenue cycle operate more efficiently.

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  1. Use the right tools. Deploying claims management technology to work in tandem with your EHR so you can automate insurance verification and charge capture is an effective way to simplify the collections process. With patient responsibility now making up a larger portion of practice revenue, tools that make it convenient for patients to understand what they owe and pay their bills electronically are just as important.

With that in mind, you’ll need:

  • A payment estimation tool to provide patients with cost estimates
  • Digital payments processing tools that enable you to store credit cards on file, set up automated payment plans and let patients pay online

Waystar, the combination of Navicure and ZirMed, simplifies and unifies your complete revenue cycle with solutions that make it easier and faster to maximize revenue and optimize results. For even more ways to remove the weeds that are hindering financial success and keeping your revenue cycle in peak growing condition, download our white paper: Seven Steps to Improve Healthcare Revenue Cycle Management.

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