As most doctors will say, health care is about helping patients, not making money. However, these two goals aren't as separate as some would assume. To support their patients, health care providers need to buy equipment, pay salaries, and spend money to maintain a productive, efficient customer experience. Revenue is what makes healthcare work, so optimizing revenue should be the main priority for healthcare administrators. That's how Mike Nicholson, Founder & CEO of Revenue Management Corporation (RMC), approaches his work.
"Revenue optimization is a term that we use in our organization to talk about how we're going to ensure that we're maintaining all the money that we can collect for the services that our clients provide," Nicholson says. "Everyone is being asked to do more with less, and patient access or the revenue cycle is no different than the clinical areas. We have to ensure that we're able to collect all the money and all the income that our clients generate as an organization so that they can put more money back into their communities which allows them to provide more services to more patients."
For help with revenue optimization, Nicholson's team uses their internal RMC Analytical Dashboard. The full suite of RMC's revenue management products help clients facilitate patient access, manage contracts, process and submit claims, and streamline collections. Here's a closer look at how RMC approaches each stage of the revenue optimization process.
Contract Management
One of the most common clogs in revenue management comes from unclear contract management. Without the right data to analyze contract compliance, practices will struggle to get accurate payments from insurers and customers.
Nicholson says that one of the cornerstones of his revenue optimization philosophy is reducing the avoidable denials; RMC's contract management tools can analyze and audit contracts to ensure payer compliance and clarify anything that could lead to such a denial. RMC's contract management tools also provide patients with more accurate estimates of treatment costs.
Having accurate contract management data can make a big difference at both the point of service and in later payment collections. RMC's contract management tools can not only increase the revenue a practice collects, but they can also improve the financial experience and build better relationships with customers and insurers.
Everybody makes mistakes, but given the amount of stress that healthcare providers are under, it’s more likely that they’ll make mistakes on routine paperwork like claims forms, which can lead to the kind of rework that hospitals loathe and that eats away at revenue.
On top of that, without a streamlined system in place, it’s often unclear where the initial problem occurred, which means administrators can’t correct the problem for next time.
“We make sure we’ve done all the work in the beginning to prevent the rework,” Nicholson says. “One way we can do that is by using that lean process that assists us with identifying where our clients can improve.”
RMC's solutions helped practices develop that type of process. RMC helps organizations prioritize the claims that need immediate attention, which saves time and reduces the number of tardy claim submissions. To avoid errors in the claims themselves, RMC's Analytical Dashboard ensures clean claims are submitted the first time, eliminating the dreaded rework.
Collections
Submitting new claims after denials are aggravating, but bad debt write-offs are even more harmful to revenue optimization — it’s money that the organization will never see, no matter how much more work is put in.
The only way to ensure accurate collections is to minimize the risk of denial in the first place. As Nicholson says, a key component of optimizing revenue is moving back-office work to the front end. For collections, this means accurately verifying patient identity and analyzing litigation risks.
Of course, not every situation can be accounted for, and there will always be issues with collections, RMC's collections solutions make it easier for organizations to prioritize their past-due accounts and pursue them effectively.
No healthcare organization will ever receive 100 percent of the revenue it’s due, but taking the right steps to optimize revenue can mitigate much of the loss and keep things running smoothly. With healthy revenue management, healthcare providers can better help the people who need them most.
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