Revenue Cycle Management woes faced by a clinic manager

Patients visit clinics. Whatever may be the issue of the patients, the clinics are entitled to claim their money by medical insurance. The records of the patients are handed over to the insurance companies by the clinic. With an increase in global population, the clinics are filled with patients. Every patient is unique, and there is a problem of handling the vast data entry work which needs to done by the clinic manager and the staff. The clinic manager also needs to look after the other duties in the clinic.

Every step of the revenue cycle management is an arduous task. The difficulties faced by the clinic manager are as follows:

Continuous monitoring of Staff training

The staff who are at the clinic’s reception should be well trained. They need to capture the patient’s entire data and in an accurate manner. The forms should be in a format which will best get the patient’s information and also make it simpler for the claims department to get the patient’s data. Although staff training might be time taking process, it has its benefits in the revenue cycle management. The old staff needs to be replaced by new, and this needs to be taken care of by the clinic manager.

Denial of claims

Often claims are denied. This happens mostly because the documentation of the patient was not entered correctly. The errors in the demographics, charting, claim submission, etc., are prime reasons as to why a claim might be denied. The clinic manager needs to assign a team for denial management to make corrections and resubmit and follow through with the insurance.

Incorrect EMR entries

One of the worst nightmares that a clinic manager face is the errors in the EMR (an electronic medical record) of the patients. The doctors, assistants and billing team mostly fill these EMRs. Since they have very little time to enter the patient charts, sometimes the doctors enter incorrect codes. There may be updates which the doctor has not yet realized because of the busy schedule. This is where professional coders come into the picture. They correct the codes. Since coding is a highly skilled work, using a professional coder proves much costlier for a clinic. So a clinic is always looking for a billing manager who can do coding as well as billing. But if the whole RCM process is dependent on one single person it is going to be a much delayed process with a lot of pending claims. The clinic manager should take care of this and it is a bigger headache with piling up of denials and shortage of staff.

Financial policies

Many clinics do not have a proper system for passing on information to staff and patients about finances. All the billing staff must know about dealing with denied claims. Patients must get information about collections, unpaid balances, or other payable agreements.

Collection, billing errors

When there is a shortage of staff and piling up of claims, errors in billing and collection of the payment by the staff is bound to happen and it going to cost dearly.

Stagnation of claims

If there is a delay in submitting the claims and repeated denials, then there is a lot of stagnation of claims, mainly because of incorrect data entered or incorrect coding. The clinic manager has to address the insurance company and then has to deal with why the claim was denied.

Which revenue cycle management tool to choose?

The advancement of technology brings a new headache to everyone. Now the clinic manager has a lot of options to choose from. They need to assess the sophistication of the revenue management tool and decide whether it suits the needs of the clinic. All this has to be done at their own time. This adds to the woes faced by the clinic manager.

Communication

There should be a smooth flow of communication between the doctors and the front-end staff so that the EMR entries are more accurate. Then only the denials may come down.

Accounts receivable

The insurance company of the patient pays for the patient’s problem. It is the headache of the clinic manager to make sure all A/R are paid. That means a lot of follow-ups to do and the manager most of the time do it themselves or has to engage staff having them work extra hours.

Can it be Outsourced?

By outsourcing the revenue cycle management, the manager can save the clinic’s finances from further damage. The clinic manager again has to choose the areas to be outsourced. Outsourcing is another pain as the data needs to be checked twice. Once the hospital staff checks, later on, the outsourcing company checks. In all this check time gets wasted and the clinic manager would be held responsible.

How to overcome the problems faced by the clinic manager?

Maintain transparency

With all the rush and emergencies, the staff must maintain transparency at all times. There should be transparency in the cost and liabilities before the treatment of the patient starts. The EMR should be such that it takes the burden off your staff both medical and non-medical, to remember the proper billing requirements.

Right revenue cycle model

Pick the right revenue cycle model best suited for the clinic and make sure that everyone sticks to the format.

Use the data

Make use of the data in the right way. To track and keep a record of the patient’s data received. Enter the patient’s data accurately. Make sure that the staff is prepared for that. The data should be captured in a meaningful way. All the data captured should be reviewed.

Feedback

Feedback also needs to be taken from patients. The input needs to be adhered to strictly. Changes are to be made according to the feedback.

With all these things and the pressures of maintaining a clinic, the job of the clinic manager is a hectic one, and they should be truly appreciated.

Revenue cycle management is an entirely hectic system. A team of people should be employed by the clinic to take care of this management cycle and not overburden the clinic manager. One other option would be selecting one of the best companies to outsource at least part of the RCM process so that they can handle it and the in-house staff can be utilized to serve the patients and assist doctors as needed. This would also bring down the cost since outsourcing to countries like India has become much cheaper and they are very conscious about the quality of work because they do not want to lose clients.