By Quennel Kappenman, RVP of Operations
Revenue cycle management (RCM) is key to the success of any cardiology practice, whether you’re a seasoned owner or transitioning to independence.
RCM includes every step of getting paid for the care you deliver, from booking appointments to receiving payment. Your RCM processes directly influence your schedule, cash flow, and quality of patient care.
Effective RCM starts on the front end, before patient care occurs and claims are submitted. This stage is known as “front-end RCM.” Errors in this stage can cause payment delays that threaten your practice’s financial health. In fact, front-end RCM issues are responsible for a large portion of claim denials.
Here’s how to solve five common front-end RCM challenges facing cardiology practices.
Top 5 front-end revenue cycle management challenges
Think of the claims process as an assembly line. The line begins with the first patient appointment, moves through insurance eligibility verification, and culminates in the cardiologist’s clinical notes and CPT codes. Each stop on the line is vital to your practice’s success.
Here’s where that assembly line breaks down on the front end—and how to fix it.
Challenge 1: Ensuring timely patient collections
Patient balances make up an increasing percentage of total claim reimbursements, and independent physicians often struggle to receive these payments efficiently. Each day of payment delay directly impacts your practice’s cash flow.
In particular, it can be challenging to secure payment from self-pay patients and those with high-deductible health plans, who have higher out-of-pocket costs and more complex billing situations.
Best practices: Set a goal for percent of co-pays and payments received at the time of service. Prepare messaging and training material for front-desk staff so they’re more comfortable asking patients for co-pays. Offer payment plans for patients with self-pay or high-deductible health plans and train staff to educate patients about their availability.
Challenge 2: Optimizing patient intake
Claim denials come from a variety of bumps along the road, like registration errors, eligibility and authorization problems, and services that aren’t covered. In fact, about 50% of claim denials occur because of problems or errors on the front end.
Accurately building claims from the beginning prevents issues further down the line. Simple mistakes like incorrect birthdays or outdated insurance information can result in denials, forcing staff to invest valuable time in reprocessing and appealing claims. It’s hard to catch and fix these issues retroactively.
Best practices: One way to mitigate future denials is to ensure all scheduled events have gone through a quality review to verify:
- Correct payer information
- Practice/provider’s network status with the patient’s plan
- Eligibility with payer portal to ensure the patient’s information was entered correctly and check coordination of benefits
- A referral for the service on file if needed
- Prior authorization on file in the patient’s chart if required for the service
If your front-end RCM team is overwhelmed by these responsibilities, it’s wise to partner with a team of experienced specialists who can help mitigate these errors.
Challenge 3: Reducing administrative burdens
Cardiology practices often struggle to manage the heavy administrative burdens caused by prior authorizations, payer referrals, and eligibility verification. These tasks can be time-consuming and often divert attention from patient care.
Unfortunately, the adoption of technology to streamline these processes has lagged due to the absence of standardized clinical documentation. This inconsistency makes it difficult for practices to implement efficient solutions that could lighten the administrative load. As a result, staff may find themselves overwhelmed with paperwork and follow-ups, leading to delays in care and potential revenue loss.
Best practices: Practices need to invest in technology that automates these processes and standardizes documentation across the board. Use prepopulated forms, set up notifications in your EHR for procedures that commonly require prior authorization, and educate office staff on workflows to ensure consistency. As you seek RCM efficiencies through technology, seek solutions built specifically for cardiology practices, such as the Rhythm® Integrated Technology Platform.
Challenge 4: Capturing charges efficiently
In addition to ensuring claims are completed accurately, practices must make sure they’re submitted on time. There’s always a lag between when you see a patient and when the claim is submitted. However, too much lag time – or inconsistent lag time – can lead to uncertainty in the revenue cycle and delayed reimbursements.
Best practices: To make sure you’re billing on a consistent schedule, ensure physicians complete patient charts immediately after encounters or within 24 hours. Train billing staff to code in a timely manner, and instill a quality check process to ensure claims are accurate. Automations in your billing software or EHR can help expedite this process. Reducing lag days through efficiencies in your process will help you create a consistent revenue cycle.
Challenge 5: Building your team
While health systems have dedicated teams to oversee all aspects of the billing process, independent cardiologists have to build their staff from scratch. But finding and retaining front-end RCM specialists can be costly and difficult. Turnover among front office staff across all practices hit 44% in 2022 and has remained high ever since.
Frequently training new staff on workflows can lead to errors and lag in claim building. Identifying a staffing model that works for your practice and keeps employees happy is key. When you find the right people for office staff and invest in training them, invest in benefits as well.
Best practices: Many employees leave smaller private practices because they don’t offer benefits packages. A partner, like a medical service organization, can build full benefits offerings for your practice employees to help ensure longevity.
Benefits of working with a partner
Front-end RCM challenges can distract you from what truly matters: patient care. If you’re noticing lost revenue opportunities or struggling with administrative tasks, it may be time to enlist expert help.
One experienced cardiologist realized that administrative demands were pulling him away from his patients. As he shared with us, “I know I’m losing money, but I don’t know where.”
Partnering with experts who understand the unique needs of cardiology practices can make all the difference. At CardioOne, we start with a comprehensive assessment and free financial analysis—followed by tailored technology, optimized workflows, and a stronger payer contracting network.
By optimizing your front-end RCM, you can lower operational costs, improve financial performance, and enhance your patient experiences. You chose independence to focus more on patient care. We’re here to ensure your revenue cycle supports that goal, allowing you to deliver the highest quality care.
Next stepsTalk with us to learn how to secure your practice’s financial future.
