The 7 Steps of Revenue Cycle Management for a Behavioral Healthcare Practice
Efficient revenue cycle management (RCM) is essential for behavioral healthcare and substance use disorder programs to facilitate a steady cash flow while reducing operational costs. It involves several interconnected steps that are critical for the success of any healthcare organization. By streamlining the clinical, administrative, and financial processes, organizations can ensure a smooth flow of revenue and offer enhanced patient care. This article outlines the seven steps of the revenue cycle management services to boost your knowledge on this vital aspect and sheds light on how AZZLY® can help with effective RCM.
Step 1: Pre-Registration
In the first step of the revenue cycle, patients need to provide essential information to the healthcare practice, such as name, address, date of birth, and insurance details. This step allows the practice to verify the patient’s identity and insurance coverage, which is crucial for proper billing and revenue management. The risk of one digit being off, a name spelled wrong, a middle initial wrong, or an address wrong can cause a claim to be denied. Human error. Review for accuracy.
Step 2: Insurance Verification and Authorization
Insurance verification is a crucial aspect of revenue cycle management in healthcare. During this step, admissions staff verify the insurance coverage details provided by the patient. They confirm the type of plan, coverage limits, and applicable deductibles, as well as the need for pre-authorization for certain services. Again, attention to detail is critical. Garbage in, garbage out. Human error happens way too often in these first two steps. With AZZLY’s next-generation EHR and RCM software available for addiction treatment and behavioral healthcare programs, this process has become much more streamlined and efficient in reducing human errors.
Step 3: Patient Check-In and Registration
During patient check-in, the medical intake staff collects additional details required for billing, such as the reason for the visit, medical history, or existing conditions. Accurate medical documentation is crucial for determining the level of care that the individual is placed in and, therefore, the charges for services rendered. The modern technology offered by AZZLY lets staff digitize patient information for efficient and secure data management and sharing for patient care management by a program’s team of providers, yet capturing all data in one system for ease of billing and reimbursement follow-up.
Step 4: Medical Coding and Charge Capture
Once healthcare providers deliver the services, it is time to translate these services into standardized billing codes. Accurate billing is fundamental to avoid claim denials and ensure timely reimbursement for the healthcare services provided. By using AZZLY’s software, healthcare providers can improve the accuracy of the billing process and reduce the risk of errors. Creating an accurate charge master and fee schedule that is updated when needed is critical. Associating the proper fee to an appointment type or to an encounter can automate this process to lessen the human error that happens in step 1 and step 2.
Step 5: Claim Submission
After translating services into billing codes, the process moves to submit claims to insurance carriers for reimbursement. If all are in one system, the organization eliminates the risk of human error. Managing this process effectively is essential for quicker payment, as claims with discrepancies or missing information may lead to payment delays or rejections. AZZLY’s RCM solution can automate and streamline claim submission for healthcare practices, enhancing operational efficiency and easily identifying the reason for denial for a prompt resubmission. Again, usually, it is a human input error in the earlier steps.
Step 6: Payment Posting
In this step of the revenue cycle, payments received from insurers and patients are reconciled with their respective accounts. Accurate posting and tracking of incoming payments are vital for maintaining an up-to-date financial record and smooth cash flow. With AZZLY, healthcare organizations can have a real-time, integrated view of all payments to ensure timely revenue stream management. Auto posting of claims is a big time saver for all billers.
Step 7: Denial Management and Follow-Up
Once claims are submitted, some may be denied due to various reasons, such as incorrect data entry on steps 1 or 2, billing code errors when a charge master or fee schedule is not kept current, or a lack of pre-authorization. In this step, healthcare organizations need to identify the reason for denial and make the necessary corrections before re-submitting the claim. AZZLY’s software enables the billing staff to access detailed reports and view patterns that can help them manage denials more efficiently.
Wrapping Up
These seven steps of the revenue cycle provide a comprehensive overview of how AZZLY can help behavioral healthcare programs with effective RCM. Through improved accuracy and streamlined processes, healthcare providers can benefit from enhanced operational efficiency and timely revenue management. If you’re interested in learning more about how we can help you manage your revenue cycle and improve financial performance, contact us at hello@azzly.com or 1 (888) 400-3201 today. You may also schedule a time to speak with your Regional Account Manager here. Thank you for reading!
