Adopting a Clinically Driven Revenue Cycle

A clinically driven revenue cycle is one of the most effective ways to help improve outcomes and prevent denials from occurring. This involves the integration of clinical data into claims processing, which can reduce claims denials significantly. This process can also result in lower accounts receivable days and increased net cash collections.

A clinically driven revenue cycle is a holistic approach to Revenue Cycle Management (RCM) Services that focuses on patient care throughout the entire healthcare process. This approach is beneficial to both the patient and the healthcare organization as it ensures that the best possible care is being delivered while also maximizing revenue. It is the combination of clinical expertise and RCM in which the collection of clinical data is used to make informed decisions about claims to proactively identify issues and potential denials before claims submission.

Implementing a Clinically Driven Revenue Cycle

Adopting a clinically driven revenue cycle is more than an IT implementation it involves changing the way care is delivered within the culture of an organization.

• Organizational Alignment: It is essential that physicians, nurses, clinical staff, and revenue cycle staff are all aligned with the clinically driven revenue cycle approach. This will ensure that everyone is working together toward the common goal of providing high-quality patient care while maximizing revenue.
• Technology: Proper training and use of technology is critical to automate tasks, improve communication and coordination among staff, and provide real-time insights into key performance indicators.
• Processes: Standardized processes are necessary to ensure that all staff members are using the same procedures and protocols when interacting with patients and processing their information. Staff must be properly trained on best practices.

Benefits of a Clinically Driven Revenue Cycle

A clinically driven revenue cycle is not a one-time implementation but rather an ongoing approach to RCM that should be regularly evaluated to ensure the organization remains aligned with current clinical best practices. A clinically driven revenue cycle will result in:

• Improve Patient Care: The focus on patient care throughout the entire cycle helps ensure that patients receive high-quality, coordinated care that is more efficient and effective. By improving care and reducing complications, patients can achieve quicker positive health outcomes or require less expensive interventions on continued treatment. Patient-centric care improves overall satisfaction, which can result in higher referral and retention rates.
• Improve Efficiency: A clinically driven revenue cycle streamlines processes and eliminates redundancies, improving patient care.The ability to document clinical care in a more concise and structured manner can help reduce the time needed to complete documentation, improve communication among staff, and support better patient outcomes.Real-time reporting capabilities allow for better insights into key performance indicators that lead to improved decision-making within your organization.
• Boost Revenue: With better care delivery, healthcare organizations can expect an increase in revenue as patients are treated more effectively. Boosting clinical outcomes while reducing claim denials allows organizations to grow their bottom line  especially when the expenses associated with RCM (e.g., call center costs, billing errors, etc.) are taken into account.
• Reduce Denials: Healthcare organizations can expect a decrease in denials as all aspects of the revenue cycle are aligned with clinical best practices – from eligibility and insurance verification to coding and billing.
• Reduce Costs: By automating repetitive tasks where possible, healthcare providers can spend less time on non-value-added activities and focus on higher-value work that improves patient care.
• Improve Compliance: A clinically driven revenue cycle can assist with compliance as it provides staff members with the tools they need to address patient care, coding, billing, and reimbursement requirements.

For a healthcare organization, adopting the clinically driven revenue cycle is a win-win situation. It’s a collaborative effort between the revenue cycle and clinical staff that requires commitment from everyone within the organization.

iPatientCare provides Revenue Cycle Management for providers across the United States. Our team manages all aspects of provider billing from claim submission to denial management. If you are interested in boosting your practice’s revenue and reducing denials contact us today to learn more about the benefits of a clinically driven revenue cycle.