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7 Ways Small Practices Can Maximize Their RCM


It's not impossible. Smaller providers can maximize their RCM and increase their bottom line; here are seven ways to do just that.

Besides providing their patients with the highest quality of care, the main thing all physicians want to do is maximize their revenue cycle management (RCM) and generate the largest amount of net revenue possible. Unfortunately, things like coding compliance, claims denials, and increasing technology expenses make this goal challenging.

However, with solid strategies, smaller providers can maximize their RCM and increase their bottom line. Here are seven ways to do just that:

1) Treat RCM Compliance Seriously

As more providers and health systems are hit with audits, it becomes even more import to treat compliance seriously. Accurate billing has taken precedence since the transition to ICD-10 and it’s more important than ever to ensure your billing team has realistic expectations.

2) Always Look for Ways to Improve

It’s easy to become complacent in anything we do. Just as weightlifters have to continue to add weight if they want to see any gains, providers also have to keep looking for ways to improve their RCM to see gains.

Providers should ask themselves on a monthly basis: How can our processes become more efficient? How can we reduce cycle time? How can we reduce waste? How can we improve our current performance levels? How can we maximize cash flow? How can we reduce bad debt while improving on denials and underpayments?

3) Integrate EHR and practice management software

Many practices currently use electronic PM systems to manage their billing and accounts receivable. Those that have adopted EHRs may also still use paper superbills that require separate data entry. This setup is inefficient and prevents practices from optimizing their revenue cycle.

When providers integrate their EHR and PM systems, they are able to capture charges at the point of service. That data can then be sent directly into the PM system where billing staff can review charges and submit claims.

Integration of IT solutions can also help small practices reduce the risk of data entry errors and decrease time to claim submittal. The end result is faster reimbursements and better quality reporting, which will help practices participate fully in future quality-based reimbursement models.

4) Manage Denials

A big part of maximizing revenue is managing claims denials effectively. To do this your staff must be proactive and diligent. For instance, an important front-end strategy to reduce denials is training your staff to verify insurance eligibility at check-in. On the back-end, it’s important you develop processes to monitor denials as they come in.

While it may not always seem worth the effort to resubmit denied claims if the claim return is small, all of those small amounts can add up to thousands of dollars in lost revenue.

A quality PM system can come in particularly handy here because it can scrub claims, manage denials, and even highlight any patient eligibility problems, thus speeding up reimbursements.

5) Training

Physicians don’t go to medical school to learn about coding and billing and collections. Because their particular expertise does not always align with their revenue cycle goals, it’s important that they find the time to get trained.

The more physicians and their staff can get educated about the different facets of RCM, the more they will be able to create workflows that increase their bottom line.

6) Analytics

Too few practices are using analytics and this is one of the best ways physicians can maximize their RCM.

No matter what the next compensation model might be, practices who track their cost containment efforts and improvements to patient outcomes will always come out ahead.

7) Consider Outsourcing

Running a small practice generally means forming close relationships with your patients and their family. The result is often past-due balances and collections that never happen. Letting payments slide is simply bad for your practice’s bottom line.

Outsourcing your billing needs will allow you to keep a close relationship with patients and get paid at the same time. Plus, outsourcing frees up time that staff could be using in other areas of your practice.

Though it may not always feel like it, maximizing your practice’s revenue cycle is in your control, regardless of changes that may take place in the healthcare industry. While it is essential you leverage tools such as EHR and PM systems, it is equally important that you and your staff become more educated on effective billing and coding strategies and automate as many tasks as possible to free up precious time.


Alex Tate is a health IT fanatic who is passionate about technology and its revolutionary impact on the healthcare industry. He adds value to the healthcare community by providing answers to problems faced by the providers. He is always hunting hot topics and opportunities that will open new dimensions in the field of Health IT.  He can be contacted at alex.tate@curemd.com


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