The Revenue Cycle Management (RCM) process is a progression of events that take place from the time a patient makes an appointment to the time the Provider is reimbursed for the delivery of care. When done effectively with no errors that RCM process will be a success and the Provider will get reimbursed in a timely manner. However, a successful RCM outcome is not always the case following the scheduled appointment. The most important section of the entire RCM process is what takes placed during the front-end process. If your front-end process is not up to par, then your back-end process will surely suffer. Lets look at the main front-end steps, basic challenges, and possible solutions.
The Front-End Journey Step One:
The front office schedules a patient for an appointment and registers that patient within the database. During this step, all basic data needs to be collected on the patient.
Bad quality data hinders the first step from being successful. Bad quality data is when information is missing or incomplete, such as duplicate data being registered into the database or the data has typos (typical human and computer mistakes). Also, missing signatures is classified as bad data. Missing signature, duplicate data, typos, missing information and more bad data processed on the front-end leads to claim denials on the back-end.
Collect detailed patient information by incorporating time-saving strategies, like taking a patient’s blood pressure and recording the patient’s weight within the waiting room to help streamline the patient registration process. Many providers have started making the data collection process virtual with the help of their RCM partner and time saving automation of a iPad or Kiosk method (technology). And include routine last minute reviews of all patient information before submission.
The Front-End Journey Step Two:
The front office verifies patient eligibility and authorization at check-in. During this step, front office staff collects insurance, authorization and other information to check the patients eligibility before services are rendered.
Key questions are not being asked on the front-end to yield the correct answers before the care is delivered to the patients. Eligibility and authorizations snags are one of the most common reasons a claim gets denied on the back-end of the RCM process.
Ask the right questions for all patients each and every time they come to the practice: Is the patient covered? Is the patient covered for other additional insurance? Is the registration information accurate? How many maximum allowable visits are there? How much of the cost is the patient’s responsibility? This should be done during subsequent visits as well. Most providers have added a RCM partner with Eligibility, Benefits, and Authorization processes in place (EBA) to their team. Asking the right questions and ensuring that all information is acquired before care services are rended will help bring RCM front-end success.
Now is your chance to tighten up your front-end process so that you can have front to back RCM success. We are still early in the year and you have time to get a RCM partner on your team to help you start managing the claim process instead of letting the claim process manage you. Having good data versus bad data and asking the right questions will help you on the front-end. But, having a team to strengthen coding complexity, miscommunication, and medical billing errors will make a huge difference at the back-end of your RCM process. Contact IntuitiveRCM services to learn how our EBA program can gain you front-end and back-end RCM success.