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Mastering Revenue Cycle Management in Community Oncology

September 29, 2022

Now more than ever, community oncology practices should focus on mastering their revenue cycle management from intake to final bill collection to ensure that every patient is cared for properly and the practice is fairly compensated. Healthcare providers use revenue cycles to increase practice efficiencies, improve patient experience, and financially stabilize their practice.

By streamlining all aspects of the revenue cycle, oncological practices will optimize workflow based on data, reduce the data collection burden on staff, and increase their financial performance. But how does revenue cycle management (RCM) in community oncology work?

What is Revenue Cycle Management?

Evaluating and improving all functions within a medical practice related to its financial outcome is referred to as revenue cycle management. These revenue cycles are intended to help practices identify, track, manage, and collect all payments so that the healthcare provider can become more financially transparent and ensure that patient care is billed and collected correctly.

The Four Step Revenue Cycle

A business tracking and evaluating its revenue cycle moves through the following steps:pre-authorization and eligibility verification, charges and billing, receivables management, and revenue enhancement. However, community oncology practices may take additional steps within each of these stages to address the unique expectations that fall on healthcare practices.

1. Pre-Authorization and Eligibility Verification

This is where practices collect the patient’s insurance and financial information. Automated eligibility allows providers to see how they’ll be paid for different services and prepares patients by informing them of their financial responsibility. 

2. Charge Capture and Billing

This includes recording and submitting a patient’s services to billing. This stage can be automated or manually accomplished. In an automated capture, fewer human errors are realized. The necessary service and billing information are pulled electronically from the input system where the patient information was initially gathered.

While automation requires a computerized system designed to meet the specific coding needs of a community oncology practice, it also speeds up the capture and billing process, reduces the number of staff needed, and minimizes human errors often made during this stage.

3. Management of Receivables

The third step of the revenue cycle experience oversees the completion of the payment through correspondence with the insurance providers and the patients. Due to ongoing negotiations between insurance providers and the community oncology practice, delays can often occur during receivables management.

4. Revenue Enhancement

Data is gathered during the revenue cycle to determine where improvements can be made to the practice’s efficiencies and the resulting patient experience. Your patients can pay their bills directly through the patient portal with an integrated billing solution. You can also equip your practice management solution to remind patients of their bills to ensure you receive on-time and in-full payments. 

Common Challenges Facing RCM in Community Oncology

Though RCM improves the financial performance of practices and the patient experience and care, many community oncology practices face challenges in RCM in the following areas.

  • Claims Denials and Subsequent Appeals: Automation can decrease the staffing needed to code claims correctly and assist in the appeal process by using automated processes like bulk appeals.
  • Prior Authorizations: Accurate service coding and automated information capture can reduce issues related to prior authorizations, like using automated attachments that are included along with authorization requests.
  • Patient Eligibility Problems: A lack of up-to-date patient care information burdens staff with ongoing data inputting, but using real-time patient portals can minimize this issue to allow medical professionals to spend more time on patient care.

The Benefits of RCM for Community Oncology

Increased capability to analyze data will reduce redundancies in staff work with both information and patients. By utilizing a strong RCM, community oncology practices can evaluate their revenue cycle experience to see where automation or other efficiencies can be implemented. Reduced claim denials and automated prior authorization free up key staff to provide better patient care, which is critical in a community oncology practice.

With fewer staffing resources, RCM will allow small practices to put patient care at the forefront. Automated coding, billing, authorizations, and claim appeals will leave more time for patient care while increasing the financial stability of small practices.

Verdi Oncology Maximizes Practice Efficiency 

Maximizing your practice’s efficiency and improving cancer treatment for your patients and their families is critical. At Verdi Oncology, we prioritize providing clinical, technological, operational, and financial support to empower innovation in small practices across the country. Contact us to learn more about joining our network.