12 Ways to Optimize Cash Flow Through Revenue Cycle Management
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When you're not bogged down by repetitive revenue cycle management (RCM) tasks, such as verifying insurance coverage and meticulously filing claims, you can dedicate your energy to what truly matters—enhancing the quality of patient care.
Your patients are the heart of your practice. This focus can improve your patients' experience, whether during their arrival at your practice, throughout their visit, or even after they leave.
Industry stats reveal that 85% of denials are preventable, and 65% are never reworked or appealed due to a lack of time or knowledge about resolving the claim. The good news is that almost 90% of claim denials are avoidable with a proactive RCM and optometric billing solution.
An efficient RCM process is crucial for a thriving optometry or ophthalmology practice. Here are a few key areas to focus on.
1. Simplifying provider credentialing
The best eye care billing and RCM companies simplify the credentialing process by reviewing documentation to determine the provider’s participation status in the health plan, and then submitting and tracking provider credentialing applications based on insurance plan requirements.
On average, the provider credentialing process can take between 60 to 120 days, so plan early. One mistake during the credentialing process can lead to a delay, often resulting in repeating the process.
Resource: Critical Steps for Efficient Provider Credentialing and Enrollment
2. Verifying patient insurance eligibility and benefits
Verifying a patient’s insurance eligibility and benefits is critical before submitting an insurance claim to a clearinghouse or vision and medical insurance plan payers. It’s one of the easiest ways to maintain clean claims, but patient verification is often the most neglected process.
It’s important to ensure demographic and insurance data is correct by verifying plan coverage and the amount a patient may owe (e.g., co-pays, co-insurance, and deductibles).
Resource: Reduce Denied Claims With Proactive Insurance Eligibility Verification
3. Increasing profitability with accurate charge entry
Charge entry is a process where you enter valid medical billing information and assign diagnosis and procedure codes before you file a vision or medical claim. Accurate charge entry is crucial so your practice can collect maximum reimbursements, decrease payment denials and increase profitability.
An efficient RCM service eliminates the worry of entering error-free patient demographics before filing insurance claims.
Resource: Why is Charge Entry Critical to Optometric Billing?
4. Keeping up with medical billing and coding changes
Staying on top of never-ending optometry and ophthalmology medical billing rules, regulations, and code changes is frustrating and time-consuming.
Certified medical billers and coders understand anatomy and physiology, the disease process, and clinical procedures for all healthcare specialties, which allows them to apply the correct billing codes and modifiers to medical claims. Fast Pay Health codes a claim within one to two days after receiving the necessary documentation (the industry standard is two to five days).
When you outsource your medical billing and RCM services, you don’t have to worry about keeping up with certifications, staff vacations, unplanned sick days, turnover, or costly re-training.
Fast Pay Health takes patient health information (PHI) security and privacy seriously. We train and monitor our optometric billing consultants continuously to comply with current PHI and HIPAA rules. Our team uses your practice management system to minimize further security risks, prepare and transmit claims, post insurance payments, and run necessary reports.
“I recently evaluated Fast Pay Health’s performance in billing and revenue cycle management against industry benchmarks, and they surpassed expectations. They helped me through a difficult billing situation and collected 50–80% more than I had thought possible.” –Mark Rosanova, MD
Resource: 15 Claim Denial Management Solutions to Improve Cash Flow
5. Submitting accurate electronic and paper claims
Maintaining a high Clean Claim Rate (CCR) requires well-defined revenue cycle management processes. Fast Pay Health maintains a 98% CCR by helping you determine how to bill the visit and make sure claims are clean and free from errors before submitting them to vision plans and insurance companies.
Accurate information is directly related to receiving reimbursements, and clean and accurate claims get paid faster. While every eye care practice will experience claim rejections and denials, knowing how to prevent those rejections in the first place is the best cleaning solution to receive revenue quicker.
Resource: 12 Optometry Billing Tips to Improve Collections
6. Managing clearinghouse and payer rejections
Using a clearinghouse expedites reimbursements, reduces errors, and increases revenue by consolidating electronic claim submissions. A clearinghouse gives medical billers and billing managers access to thousands of insurance payers, across different states, from a single location.
While many clearinghouses offer RCM services, there are significant differences you may not be aware of before you sign on the dotted line. The most important difference is that a clearinghouse does not replace RCM; they work together.
Fast Pay Health consultants track all claims we submit electronically through clearinghouses and ensure that insurance payers accept the claims. If we notice a rejection, we promptly and manually fix the errors to ensure timely insurance receivables.
If you want to speed up the process even more, choose a clearinghouse that integrates with your eye care practice management software so you can easily manage patient and insurance billing with built-in edit checks.
Resource: Clearinghouse vs. RCM: Here’s the Big Difference
“I see Fast Pay Health as an investment rather than an expense. The team is a huge contributor to our practice’s success, and I don’t know what I would do without them. They specialize in alleviating the burden of insurance billing and giving you peace of mind.” –Julie Honda, OD
7. Posting insurance payments daily
Posting remits within 24 to 48 hours allows you to move the balance to secondary insurance and bill much quicker. At Fast Pay Health, we post payments through Electronic Remittance Advice (ERA) and standard paper Explanation of Benefits (EOB) directly into your practice management system, giving you accurate and up-to-date accounts.
We analyze unpaid claims and EOBs to correct and reprocess rejected claims to recover the amount due. With Fast Pay Health billing solutions, clients see net collections increase by over 90% in the first 30–45 days.
8. Promptly filing secondary claims
You can run into timely filing denials if a patient has secondary insurance. For instance, many payers require you to bill a secondary carrier within a specific period after you receive the primary payment. Or, if there is a balance left for the patient to pay, it becomes increasingly difficult to collect payment the longer it’s been since the patient’s visit.
When your optometry billing cycle isn’t running smoothly, it works like a domino effect. If primary claims are not filed, secondary claims and patient billing are delayed.
“Claims are now processed faster, which means we get paid more quickly. Our net collections increased by over 90% in the first few months.” –Taylor Tedder, OD
9. Researching and managing claim denials
Researching unpaid or denied claims is a time-consuming process. Once a claim is denied or rejected, most insurers set a deadline to contest the denial. If you want to increase your cash flow, reviewing all rejected or denied claims and making necessary corrections as soon as possible is critical.
Fast Pay Health optometric billers often process rejected claims for one or more reasons, such as invalid insurance information, member ID numbers and insured information, and/or the patient isn't eligible on the date of service.
Resource: Mastering Claim Denial Reason Codes Expedites Cash Flow
10. Focusing on accounts receivable cleanup and insurance follow-up
Are you focusing on accounts receivable (AR) and pesky aging claims daily to see why open balances are still outstanding? Accurate information directly relates to you receiving reimbursements—claims get paid faster! Our RCM specialists analyze unpaid claims and then take the necessary steps to recover the amount due.
You must look at the number of “Days in AR” and your “Net Collections” together. Days in AR may be at or above industry best practices, or Net Collections may be low because your medical biller merely writes off denied claims rather than following up with insurance companies.
Your Fast Pay Health account manager provides weekly activity and financial reports so you have insight into your AR status and benchmarking data. Better visibility means you can make more informed business decisions for your practice.
Resource: Calculating ROI for Outsourcing Optometric Billing and RCM
11. Avoiding reimbursement delays with insurance claim audits
Before you submit insurance claims, they must be clean and error-free. We review AR aging claims daily to see why open balances remain outstanding. Preventing those rejections in the first place is the best way to increase your cash flow and improve your bottom line.
Resource: Preparing for a Vision Plan and Medical Insurance Billing Audit
12. Reducing expenses using patient statement services
Are you having difficulty keeping up with printing and mailing patient statements? With a complete RCM service, you can reduce expenses, boost your revenue, and eliminate the time-consuming task of in-house printing and mailing.
Fast Pay Health will print and mail patient statements for your practice through our HIPAA-compliant print and mail service partner. Statements are typically mailed within 24 hours (during regular business hours) after receiving insurance payments. Or, we can print your patient statements to an assigned printer in your office so that you can mail the statement to the patient.
Schedule a free practice analysis and see how Fast Pay Health optometry and ophthalmology billing consultants take a proactive approach to help you get paid faster and improve the financial performance of your practice.