4 Major RCM Killers (and How to Fend Them Off)

As the old adage goes, your best offense is a good defense—and no one knows that better than the folks responsible for revenue cycle management (RCM). When it comes to rehab therapy billing, getting dinged with claim denials might seem inevitable. But, taking steps to avoid the following four RCM killers will help you shield your practice from taking a critical hit.

1. Ineffective (or Non-Existent) Payment Policy

Money talks, and when we’re talking money, there’s no room for murkiness. Making sure your payment policies are crystal clear not only benefits you and your staff, but also sets a straightforward expectation for your patients. In this post, I highlighted the essentials of a successful patient payment policy. Check it out to see whether your practice’s payment guidelines are up to snuff. Once you’ve got your policy on lock, turn your focus to effectively enforcing it.

Define staff roles.

Think about your favorite band. What makes them sound so good together? Well, it all starts with the predetermined role of each individual member. The vocalist sings the melody, the guitarist pulls the rhythm and main tune together, the bassist brings depth to the sound, and the drummer keeps everyone in time. But, what if those distinctions weren’t so clear? What if there was no communication among bandmates? Some music aficionados might call the end result “jazz,” but more likely than not, it would be total chaos.

The bottom line: In any group—whether it be a band or a rehab therapy staff—having clear role definitions is a surefire way to ensure each individual uses his or her time and skills to the fullest. That includes outlining each person’s responsibilities with respect to payment processes.

Trust—but still verify.

Generally speaking, billers shouldn’t be responsible for front office work, just as front office staff shouldn’t be responsible for handling claims. A good way to prevent your biller from doing extra work is to record and verify all the correct intake information before a patient ever sees the therapist. That means implementing policies that ensure you cover all your bases by verifying information like:

  • insurance benefits,
  • demographics,
  • the name on the policy, and
  • whether or not there’s a secondary insurance.

It’s also vital that you collect patient copayments at the time of service. Doing so eases the pressure on your front office staff, as they won’t have to chase down patients with past-due balances.

2. No Follow-Up

Your practice—just like any other business—relies on a steady cash flow to keep things running smoothly, but you can’t always rely on payers to reimburse claims in a timely fashion. However, you can control how long it takes your clinic to follow up on unpaid amounts—whether those are payer reimbursements or patient-owed balances.

You should send your patients regular invoices, and when a patient whose payment is overdue comes into your clinic, give him or her a friendly, in-person reminder about the outstanding balance. A personal interaction is more likely to result in a payment. Also, be sure you’re sending patients their invoices in a timely fashion, as they’ll be less likely to dispute charges.

Additionally, your biller should follow up with insurance companies “every 30, 60, 90, and 120 days” regarding any unpaid or underpaid claims. Doing so will help your biller identify simple billing mistakes sooner rather than later, which means you get paid faster.

3. Failure to Identify Error Trends

Some folks say the definition of insanity is doing the same thing over and over, yet expecting different results. While I can’t say that making the same claim errors over and over is “insanity” per se, it is—if nothing else—exhausting. In a busy practice, it’s normal to for a biller to ship claims off as soon as they’re generated. In fact, it’s expected. However, if your biller is sending out claims one at a time, he or she could be overlooking high-level processing trends that are clogging up your RCM cycle.

The solution: Implement processes that identify workflow and coding errors that repeatedly lead to claim denials. For example, you could create an Excel spreadsheet and start tracking remark codes and downcoded claims as your practice receives them. This data will help you pinpoint recurring hiccups on both the billing and documentation sides—which you can then take steps to correct. After all, a denial here or there may not seem like a big deal, but collectively, they can really add up—and seriously stop up your cash flow.

4. The Wrong RCM System

If you use an electronic medical record (EMR) system, then you already know the benefits of housing your patient records in a secure, cloud-based platform. But, what about your RCM software? With so many options available today, choosing the right one for your practice may seem like a daunting task.

You might be thinking, “Does it really matter which RCM software I use? They’ll all get the job done, right?” The truth is, no two RCM systems are created equal. On that note, you should take the following into consideration when vetting potential RCM solutions:

  • Does it integrate with your EMR?
  • Is it up-to-date on compliance changes?
  • Does it have coding checks in place to avoid common errors?
  • Does it offer robust reporting?

If your current RCM system doesn’t measure up on those fronts, then it might be time to consider a new billing software. After all, if your RCM system doesn’t streamline your revenue process, you could end up losing out on a serious chunk of change down the line.

Defending your clinic’s RCM process doesn’t require any superpowers—or an actual shield—but it can mean the difference between having a practice that thrives and one that struggles to stay above water. Defining—and refining—your RCM process puts your practice on the road to success, with you in the driver seat. And, by identifying billing challenges and implementing policies that defend your financial procedures, you can be the RCM hero your practice deserves.

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