How Revenue Cycle Management Consulting Can Help Build Claims

Healthcare providers have to submit requests for payment to insurance companies regularly. The claims process needs to happen quickly and accurately. A common way to achieve that speed and accuracy is to use revenue cycle management consulting experts to handle the claims. Here’s how an RCM consultant can assist with building claims.  

Optimize Processes

Revenue cycle management consulting experts can do a deep dive into the existing claim submission process. They gather patient information, submit claims, and handle denials. Through their analysis, RCM consultants pinpoint areas where things get clogged up. These bottlenecks can be due to manual data entry, lack of clear communication between departments, or inefficient coding practices. Once the consultants identify the bottlenecks, they can automate repetitive tasks, like eligibility verification or claim submission. They can also install new software and standardize coding practices. These measures create a smooth, efficient flow that results in quick claims processing and reimbursement.

Promote Compliance

An RCM consultant knows the latest claims regulations, and they use the correct codes to guarantee claims approval. RCM consultants also review medical records and verify proper documentation and use of codes according to industry standards. They submit claims electronically and in the proper format.

The claims process involves solving complex tasks with specific software and data requirements. RCM consultants lower the risk of denials and penalties from insurance companies. A denied claim translates to lost revenue and requires additional staff time to appeal the decision. Penalties can also impact your organization’s ability to contract with certain insurers.

Integrate Technology

RCM consultants can assess technology systems and recommend solutions to streamline claim management. They scrutinize your existing billing software, coding systems, and communication channels. The experts then identify outdated technology and areas where information flow could be more active. They can recommend a new, user-friendly billing software to automate repetitive tasks and minimize errors. Upgrading current software could also be a suggestion, ensuring compatibility with the latest regulations and maximizing functionality.

Modern healthcare depends on the power of interconnected systems. RCM consultants understand this well and might recommend integrating the billing software with the electronic health record (EHR) system. The seamless flow of data eliminates the need for manual entry, reduces errors, and speeds up claim submissions. RCM consultants can also mine a provider’s historical claims data to find hidden patterns. Using analytics tools, they can identify areas with high denial rates or slow reimbursement cycles. 

Provide Training and Education

RCM consultants teach healthcare staff the most efficient and accurate ways to handle medical coding, billing, and follow-up procedures. Medical coding translates diagnoses and procedures into standardized alphanumeric codes that insurance companies use for reimbursement. RCM consultants train staff on the latest coding updates to guarantee claims are coded correctly from the start. As your staff learns up-to-date coding practices, they can improve the billing process and expedite reimbursements. The consultants also educate staff about the ever-shifting regulatory landscape of the healthcare industry. A trained staff makes fewer errors, reduces claim rejections, and accelerates reimbursements for services rendered. 

Monitor Performance

An RCM consultant tracks denial rates, how long it takes to get paid (average reimbursement time), and the entire duration it takes to collect money from a patient’s visit (revenue cycle duration). A high denial rate might indicate mistakes in coding or submitting claims. RCM consultants then delve deeper to identify the cause.

A long average reimbursement time could suggest issues with insurance companies or internal billing processes. The consultants can provide these reports every month. You can see trends, improvements, and areas that still need work. The information enables your organization to make informed decisions and improve its financial health. As you create an efficient RCM process, you collect money faster and reduce claim denials. 

Work With Revenue Cycle Management Consulting

Revenue cycle management consulting services act as an extension of your team. They can optimize the entire revenue cycle and improve your claims process in several ways. The experts improve your cash flow and reduce administrative burden. 


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