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Mastering Revenue Cycle Management: Strategies for Healthcare Success

Read Time:
5 Min

What You’ll Learn:

Comprehensive strategies to enhance revenue cycle processes, ensuring efficient, profitable operations.

Source: Wakefield
December 22, 2024

Empowering Healthcare with Data: A Glimpse into Modern Revenue Cycle Management

At Wakefield, we specialize in comprehensive revenue cycle management (RCM), a critical component for healthcare organizations striving for financial health and efficiency. Our services, which span the breadth of the healthcare revenue cycle management spectrum, are utilized by a wide range of healthcare providers across the United States. From small medical practices to large health systems, our expertise in managing every aspect of the revenue cycle ensures that healthcare facilities can focus their attention on patient care, while we handle the complexities of medical billing and insurance reimbursements.

Ambulatory Surgery Centers

In the realm of Ambulatory Surgery Centers (ASCs), our proficiency in healthcare revenue cycle management has been particularly impactful. Our approach to managing the revenue cycle process, from patient intake to final payment, has enabled these healthcare facilities to maximize their patient service revenue. This includes effective management of patient accounts, insurance eligibility verification, proper medical coding, and timely claim submission to health insurance companies. Our revenue cycle management services are essential for healthcare organizations looking to optimize their financial operations.

Behavioral Health Providers

For Behavioral Health Providers, navigating the revenue cycle management processes can be challenging, especially with the ever-changing healthcare regulations. Our services have been instrumental in ensuring that these healthcare providers efficiently manage their patient billing, claims processing, and collecting patient payments. By focusing on these administrative and clinical functions, we’ve helped them improve their financial performance significantly. Outsourcing revenue cycle management to experts like us can greatly benefit healthcare organizations, allowing them to focus more on providing medical services.

Revenue Cycle Management

Out-of-Network Claims & Lost Revenue Recovery

Out-of-Network claims have a much higher reimbursement potential than in-network claims. Unfortunately, a lot of providers do not realize this because the payors limit your reimbursement potential without you even knowing it. Take a look at your past year of out-of-network claims. If they seem to be doing more harm than good, something is wrong!

Nearly all provider types can greatly benefit from our Lost Revenue Recovery services, but Behavioral Health facilities in particular have a unique standing. Your billing team is likely not maximizing your reimbursement potential by recovering the full value of your services from the payors. And it’s not really their fault, either. The payors constantly change the rules, making it virtually impossible to monitor the reimbursement on one claim, much less hundreds at any given time.

Leaving money on the table due to unpaid out-of-network claims with Aetna, Cigna, or UnitedHealthcare impacts your revenue cycle and your bottom line. But there is hope! Thankfully, with our extensive knowledge of payer strategies and cutting-edge technology we have developed a unique approach that works alongside your billing team to optimize the highest out-of-network payments.

Emergency Medicine

Our work with Emergency Medicine providers highlights our ability to manage the revenue cycle management process efficiently. This includes everything from patient access and eligibility verification to the charge capture process and remittance processing. Our goal is to ensure that these healthcare practices receive the insurance reimbursement they are entitled to, in a timely manner, thereby improving their overall financial health. The medical billing process is a critical part of the revenue cycle, and our expertise ensures that correct medical codes are used for each medical service provided.

Revenue Cycle Management

Impacts of Surprise Billing on Revenue Cycle in Certain Healthcare Groups

The No Surprises Act has changed the landscape for a select number of provider types. We have a wide variety of resources regarding Surprise Billing updates that directly impact Emergency Medicine groups and other organizations. You may not even realize how the No Surprises Act is affecting your revenue cycle. It’s virtually impossible for any one person on your billing team to stay current with the ever-changing rules and regulations. We have a team dedicated to this and can help your billing team navigate the landscape appropriately, saving your bottom line.

Hospitals

Hospitals, as complex healthcare systems, require a robust approach to revenue cycle management. Our services extend to managing their accounts receivable, denial management, and ensuring proper revenue cycle management practices are in place. This is crucial for maintaining the organization’s financial health, especially when dealing with a diverse patient population and multiple insurance payers. Hospitals, as a key type of healthcare facility, benefit greatly from our specialized revenue cycle management services.

Hospitals & Complex Claims

Complex and Denied Claims can make up potentially 2-3% of a hospital’s revenue, but up to 5 times that percentage in terms of resources required to resolve them.

Hospitals and health systems can largely benefit from our numerous resources of handling complex claims. We have an entire department dedicated to these claim types and can help you identify how it’s impacting your revenue cycle. We can guide your billing team through legal concepts, innovative approaches and proven techniques to effectively navigate and resolve intricate claims scenarios. Wakefield can handle all of these challenging receivables effectively and provide attorney-intervention when necessary.

Laboratories/Diagnostic Centers

Precision and Profitability: Revenue Cycle Management in Healthcare Laboratories

We also specialize in revenue cycle management for Laboratories and Diagnostic Centers, where the focus is on accurate medical billing processes, collecting payments, and managing patient accounts. Our expertise in medical coding and submitting claims to insurance companies ensures that these healthcare facilities maintain a steady flow of revenue, essential for their sustainability. The use of medical devices in these settings further underscores the need for precise revenue cycle management to ensure accurate patient payment and insurance processing.

Our Specialty is Finding the Exceptions to Your Revenue Cycle

There are hundreds of revenue cycle management companies out there who have similar business models and offer virtually the same services. But what makes us unique is that we don’t just bill & collect. We analyze & optimize! Our automated workflow technology reduces human error by identifying the exceptions to each of your claim encounters, resulting in the improved financial health of your organization. Our clients know we are the best in the industry at what we do.

In summary, Wakefield is dedicated to providing effective revenue cycle management solutions across the healthcare industry. Our services are designed to handle every aspect of the revenue cycle, from patient access to payment collections, ensuring that healthcare providers can deliver value-based care without the burden of financial intricacies. Whether it’s a small healthcare practice or a large healthcare system, our commitment to enhancing the financial process and patient satisfaction remains unwavering.

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