Revenue Cycle Management (RCM) is a constantly shifting pattern of charges, policies, claims, and statements. You might imagine a perfectly-managed revenue cycle would be an automatic result of employing well-trained billers who expertly file claims and pursue responses. While your billing experts are certainly one piece of the puzzle, let’s take a holistic view of RCM to identify early opportunities that reduce points of friction and acknowledge that RCM success is everyone’s job.
While you work hard to keep your practice’s workflows efficient, the areas with the most friction in revenue cycle management are usually outside of your direct control. What are they?
“Payor shenanigans,” says Jan Blanchard, CPC, CPEDC, CPMA, who has more than 30 years’ experience in medical coding and billing, and keeps PCC clients apprised of changes to the coding landscape.
Blanchard explains that payor negotiations come with some common frustrations: “...Whether and how [payors] communicate with the patients. Whether and how they communicate with the practice. The nonsense responses and runaround that they create with their obfuscation around whether they've received claims, whether they’ve processed the claim. When they do process the claim, they may come back with nonsense answers. I can't think of another part of the revenue cycle that is as fraught as that.”
For many billers and pediatric practices, payor interactions are the source of most frustrations in the revenue cycle. Inconsistencies in communication, unclear or absent explanations, and ever-shifting policy requirements create confusion. A stellar billing team works hard to prevent these delays before they happen, all while responding to payor communications and patterns in real time to ensure claims get paid and the practice maintains healthy cash flow.
For all of these reasons, billing professionals are indispensable to your practice, but neither can they operate in isolation. In a system where even simple errors can cost hours of work, billing experts need the entire team’s collaboration to make your revenue cycle a success. Professional bodies like the American Academy of Pediatrics (AAP) utilize dedicated policy boards to negotiate with payors toward favorable outcomes for pediatricians. At the practice level, you can empower your billing experts by identifying internal points of friction, clearing the path for them to process clean claims with greater efficiency.
Key friction points at the practice level include administrative errors such as incorrect billing information, lapsed insurance coverage, or missing documentation. You won’t be surprised to see that many of these errors happen long before the claim is submitted, which is great news for preventing errors in the first place. Every member of your team is well-positioned to help your billing team achieve revenue cycle success from the very beginning.
Every conversation with a family is more than an opportunity to shape a patient’s experience; it is also a chance to maintain a healthy revenue cycle. Before, during, and after a patient’s visit, each touchpoint can clarify the details that build clean claims and increase billing effectiveness. As patients interact with different team members at the front desk, in the exam room, and elsewhere, it’s important to understand the role(s) that each person in your practice plays in maintaining the revenue cycle. As with many other things in your practice, success begins and ends with how you communicate with your patients.
Front desk and scheduling staff greet new families before they ever arrive at the practice in person. By confirming patient information and guiding families through your practice’s policies and procedures, front desk staff plays a key role in preventing downstream claim issues such as eligibility denials and documentation errors. Some of the items your front desk or scheduling staff should be verifying with families include:
These conversations can help prevent headaches weeks in advance. It’s not just great customer service to get clean information upfront — it’s also great revenue cycle management.
Once patients arrive, confirming demographics continues to smooth friction in the revenue cycle. Pediatricians, nurses, and support staff are empowered by coding support, prompt chart completion, and ongoing communication which can prevent delayed claims, coding questions, and avoidable denials. Clinicians can work with billers to avoid gaps such as missing documentation, incomplete diagnosis and procedure details, and more.
Billers are the professionals who know claims back-to-front. They’re skilled in identifying patterns in payor trends, claim or appeal denials, and the workflows that help get the claim submitted cleanly. Support for billers comes from not just the rest of your practice and leadership team, but also outside sources like professional coding associations, the AAP, and more. PCC is dedicated to supporting billing professionals with EHR features such as Real-Time Claim Status, which saves billers many hours by verifying a claim’s status straight away and avoids interminable telephone holds.
Leadership shapes the systems and processes that allow everyone to succeed. To support a healthy revenue cycle, practice owners and office managers can identify friction points, create and monitor improvement plans, maintain financial policies, and make the administrative decisions that simplify communication with patients and staff.
With the constant shifts in the healthcare landscape, which range from government and payor policies, and many other factors outside your control, no biller should face the beast of revenue cycle management alone. That’s why PCC EHR is designed to support pediatric patients and their families. We believe so strongly in offering and participating in community support that we convene Monthly Billing Drop-Ins to gather pediatric billers to compare notes, identify common strategies for success, and meet their peers with similar challenges. Our annual Users’ Conference hosts several courses on billing, revenue cycle management, and insurance negotiation, which count towards CEUs. Reach out to PCC at any time for new biller training, practice management support, and more.
The practices with the healthiest financial performance aren't necessarily the ones with the biggest billing departments. They're the ones who recognize that every interaction, from the first phone call to the final statement, is part of the same connected process, and everyone is a valuable part of revenue cycle success. In other words, successful revenue cycle management really does begin with hello.
PCC is here to support your billing excellence with an EHR built for pediatrics and the kind of support you can’t find anywhere else. If you’re searching for a community that will uplift your practice and help improve your billing cycle, you’re in the right place! PCC’s Billing Drop-Ins are monthly “come-as-you-can” events to discuss billing and revenue cycle management with peers. Please join us for our next monthly Drop-In by registering at pcc.com/events. Past events may be viewed here.