How To Improve Revenue Cycle Management in Your MSK Practice

Effectively managing revenue cycle is more challenging than ever. Fortunately, there are best practices that can help improve the entire process. In order to maximize the financial health of your independent MSK practice, you must streamline billing processes, optimize reimbursement, and minimize the impact of administrative burdens. Before we dive into these best practices, let's take a closer look at some of the fundamental of revenue cycle.

What is revenue cycle in a MSK practice?

Revenue cycle refers to the entire financial process of managing claims, payments, and revenue generation from patient services. This cycle begins with patient scheduling and extends through charge capture, claim submission, payment posting, and resolving any billing or insurance issues. Effective revenue cycle management (RCM) ensures timely, accurate reimbursements and minimizes delays in cash flow.

The main components of the revenue cycle include:

• Patient Access Management: Collecting accurate patient information and verifying insurance.

• Medical Coding and Billing: Translating medical procedures into standardized codes for insurance claims.

• Claims Submission and Follow-up: Filing claims with payers and addressing denials or rejections.

• Patient Collections: Managing patient payments, including co-pays and out-of-pocket expenses.

• Accounts Receivable Management: Tracking outstanding balances and ensuring timely payments.

• Reporting and Analytics: Using data to monitor performance and identify areas for improvement.

Why is effective revenue cycle management so important?

Managing revenue cycle is more than just processing claims and collecting payments. It's the financial backbone of any MSK practice, ensuring that all services provided are paid for accurately and on time. Subpar RCM practices can result in delayed payments, increased denials, and, ultimately, financial instability for the practice.

The shift toward value-based care and high-deductible health plans has also increased patients’ financial responsibilities. This has placed additional pressure on practices to improve patient collections while maintaining positive relationships with patients. Due to this complexity, practices must adopt efficient revenue cycle solutions that ensure accuracy, compliance, and patient satisfaction.

5 Key Revenue Cycle Solutions for MSK Practices

Your MSK practice can benefit from a proven solution that provides end-to-end support across the entire revenue cycle, from patient intake to final payment resolution. MedVanta's revenue cycle and Central Billing Office was built by the expert team at The Centers for Advanced Orthopaedics. It can be a model for practices looking for the most important components of a proven revenue cycle solution:

1. Comprehensive Revenue Cycle Management Partnership

Many medical practices choose to partner with a service organization that provides revenue cycle management This approach allows practices to leverage expert resources and technology without having to invest heavily in internal staff or infrastructure. This type of partnership can include services such as medical billing, claims processing, collections, and financial reporting.

By handing off RCM duties, practices can focus on patient care while ensuring that their billing and collections are managed by experts who are up-to-date on the latest regulations and payer requirements.

Benefits of partnering with a service organization include:

• Reduced administrative burden: RCM companies handle the complex and time-consuming billing and claims processes.

• Improved reimbursement: Experts ensure accurate coding and submission, leading to higher reimbursement rates.

• Scalability: As your practice grows, RCM services can scale with you.

2. Patient Access Optimization

Patient access is the first step in the revenue cycle, and getting it right is essential for minimizing delays and errors later in the process. Effective revenue cycle solutions focus on optimizing patient access by automating and streamlining key tasks, such as:

• Insurance verification: Ensuring coverage is verified before services are provided to prevent denied claims.

• Pre-authorization: Obtaining necessary authorizations in advance to ensure services will be reimbursed.

• Eligibility checks: Verifying patients' insurance eligibility in real-time at the point of care.

Patient access optimization reduces the risk of denied claims and enhances the overall patient experience by providing transparency and clear expectations regarding payment responsibilities.

3. Claims Management and Denial Prevention

The heart of any revenue cycle management solution is its ability to process claims quickly and accurately. A robust claims management systems can streamline the submission process by validating codes and checking for potential errors before claims are submitted to payers. This leads to fewer denied or rejected claims, which are often costly to address after the fact.

Additionally, sophisticated RCM systems include tools for denial prevention and management. These tools help identify the root causes of denials and provide actionable insights to prevent future occurrences. By reducing denial rates, MSK practices can significantly improve cash flow and reduce the administrative effort required to resolve issues.

Key features of claims management include:

• Robust coding validation: Ensuring that medical services are coded accurately according to current standards.

• Claims tracking: Monitoring the status of claims as they move through the payer process.

• Denials management and resolution: Identifying trends in denied claims and taking corrective action.

4. Patient Financial Engagement

Patients are typically responsible for a share of their medical costs. Depending on a patient's specific insurance plan, these costs might be significant. Effective revenue cycle solutions include patient financial engagement tools that provide clear communication about financial responsibilities and offer flexible payment options. This helps reduce the likelihood of unpaid balances while maintaining positive patient relationships.

Patient financial engagement includes:

• Transparent billing: Providing clear, itemized statements that explain what patients owe and why.

• Online payment portals: Offering convenient ways for patients to make payments or set up payment plans.

• Financial counseling: Assisting patients in understanding their bills and exploring options for financial assistance or payment arrangements.

When patients understand their financial obligations and have convenient ways to pay, they are more likely to fulfill their payment responsibilities, which directly improves cash flow.

5. Reporting and Analytics

Data-driven insights are critical for understanding the financial health of your practice. Advanced revenue cycle solutions provide detailed reporting and analytics capabilities, allowing healthcare organizations to monitor key performance indicators (KPIs) and identify areas for improvement. Some of the most important KPIs include:

• Days in Accounts Receivable (AR): The average number of days it takes to collect payments.

• Claim denial rate: The percentage of submitted claims that are denied by payers.

• Collection ratio: The percentage of billed amounts that are collected.

• Patient payment rate: The rate at which patients pay their bills on time.

By analyzing these metrics, healthcare practices can proactively address potential issues, improve processes, and enhance overall financial performance.

Need help with revenue cycle management?

Revenue cycle is the financial heartbeat of a every MSK practice, and optimizing it is essential for ensuring the sustainability and growth of your practice. By implementing comprehensive revenue cycle solutions, independent physician-owned practices can streamline operations, reduce errors, improve reimbursement rates, and provide a better overall experience for both patients and staff.

To learn about MedVanta's proven revenue cycle and Central Billing Office services, contact us.