RCM is the backbone of any healthcare practice and the smaller the practice the more dependent and more vulnerable they are to RCM errors. RCM may help in keeping track of all your operations and can provide you with more control, but this is not always the case. Most of the time unprepared RCM leaders have a lot of trouble keeping track of everything. Denied claims turn into write-offs, collections are not completed there is not a consistent ROI.
Improper communication and transfer of information alone can lead to horrendous mistakes in a RCM workflow. For example, when dealing with issues such as pre-authorizations, demographic inaccuracies etc, you need to establish a proper communication and flow of information channel with the front office. Always be aware of your data, group your denials and find common points that can provide easy solutions. I.e., for anything related to demographic denials, your first contact should be the front office. Build tangents to your solution so you can attain them easily and data can be of immense help here.
Aging AR is just one of those things that can either break or make an RCM workflow. Always ensure that you have a team on top of the aging AR, assign another team to schedule denial clarification with the carrier prioritized by their filing limit. Make sure that the adjustments taken are based on the fee schedule. Sometimes some of the carriers might miss out making payments which adhere to the guidelines, make sure that is not the case with even a single claim and that adjustments are only taken as the last recourse.
Finally, look for alternate sources of revenue. If the pandemic has taught us anything is that we always have a backup & always be sure that your workflow can adapt to strenuous times.
