Speaker 1: Hi everybody, Jennifer Blevins Smith with Integral Clinic Solutions, and you're watching my YouTube channel, Navigating the Business of Medicine. Today I'm going to start a series of videos about Revenue Cycle Management, or RCM. I am breaking this into a multiple video series because if I were to do a video about Revenue Cycle Management, it would be so long. So in the interest of time and keeping your attention, of course, I am going to break this into what I feel are manageable clumps, manageable videos to help you understand the phases of Revenue Cycle Management, what parts of the office are affected by these steps or control these steps, if you will. And then we'll talk about at the end, some of the quote, ancillary things that are Revenue Cycle Management related, but might not fall in this direct kind of cycle that I'm going to talk about. So today we're going to talk about Revenue Cycle Management and where it all begins. Revenue Cycle Management begins at the front desk or your registration staff. So if you have separate staff that register patients versus who works the front desk and checks in patients, then it would be these two different people departments. But if not, a lot of times, especially in small private practices, it's all enrolled into one. Registering patients accurately is your number one first go at making sure that this revenue cycle is initiated and started on the right foot. You get the patients on the door or they call up and they want to be seen. The front desk staff will find out whether the patient is new or if they're established and they'll go from there. They always need to make sure that they're registering the patient with the correct information. And not only are they hearing it correctly, but they're entering it into your data system as well, correctly. Any kind of incorrect address, spelling of names, dates of birth being inaccurate, insurance information data being wrong, that can all affect claims or, and, or I should say, it can affect you getting paid by the patient down the road through this revenue cycle. So it's very important that you hire people at the front desk for registration that understand why their job is so important. They're not just front desk people. They are very important to make sure that all the information they're capturing in a patient's chart and their account is correct, accurate, and that they have a friendly face and people want to come back. So attention to detail, understanding why their job is important is always a good thing to explain to them. So they want to make sure that they're getting the right insurance information, subscriber ID, subscriber information, patient name. Now the patient name can be tricky, right? Because they might want to ask them their legal name, but if the patient doesn't use their legal name at the insurance company, then they need to register the patient under the name that's at the insurance company. So if somebody is Jack something, Jack Smith at the insurance, but their legal name is John Smith, they would want to make sure they register the patient under Jack Smith in your system because that's, what's going to go out on claims and that's how they're going to identify the patient with date of birth and the name in the system as well as a subscriber ID number. So making sure that they understand why it's important and what information they get. Then once you have all that information and depending on your workflows, they need to make sure that they're checking eligibility and benefits for this patient. So the patient tells you they have Blue Cross Blue Shield and they give you an insurance ID number. You should somehow be having your front desk or whomever is responsible for this duty be checking at least a day in advance of a patient's visit that their coverage is active with the information they gave you. You don't want patients coming in and think that that insurance is good and you don't even know until you send out the claim, the patient gave you bad insurance. And you know, this happens because life gets busy. People get new insurances. They forget to tell you they updated it or they don't update the card in their wallet. So they think it's, you know, their old insurance or they have their old insurance and their new insurance and they can't remember which one is which, or they have two insurance coverages, primary and secondary, and they don't know which one is primary or secondary. So it's one of those things that it's very important to be checking and making sure that the patient is eligible with their insurance information they gave you. A lot of EMR systems now have a feature where it can check eligibility in real time through the payer's portal instead of having to log in separately to the insurance portal. But if it doesn't, then you should definitely make sure that you have someone that's going into those insurance portals and checking eligibility is active. After you know that their eligibility is active, their insurance is good to bill for when they come in, then depending on what services they're getting from you, you would want to check their benefits. You would want to see if they've met their deductible yet, if the services that they're having is even covered by their insurance plan. You know, some specialties and some things that are offered might not be covered. You might need to make sure the patient is aware that they might have to pay out of pocket for certain services if they haven't met their deductible or they have a coinsurance. You'd want to make sure that if there's a limit to their benefits, that you have that conversation with patients ahead of time. If they only cover a certain amount of units for a certain service and you, for good practice and depending on their medical need, have to provide additional units, how are you going to capture that money for that? How are you going to get that revenue back? You need to have conversations with patients before the services are rendered if you want to try to collect that difference from the patient. That's per your contracts with your insurance companies and a lot of insurance laws, rules. So how are you going to do that? Then you want to make sure that when they check in for their appointment, that they're giving you a copy of their insurance card, their driver's license, so that if you need any of that information downstream in the revenue cycle, you have it at your fingertips and you're not trying to call the patient after the fact, trying to track them down, have them call back, bring in a copy of the card or send in a copy of the card. It gets really messy. So the more you can streamline and put all of this into place ahead of time with your staff and expectations, the better off it's going to be downstream with these claims. So if the patient has registered, everything's accurate, you know their eligibility and their insurance is active, you've checked their benefits, you've had any cost share communication with the patient directly, you've collected money upfront if that's one of your policies. Of course, copays need to be collected upfront. That's part of the revenue cycle, right? Making sure that your staff upfront when they check in an established patient, if there's a balance on their account, they're collecting on that. That's part of the revenue cycle. There's so many different facets. It's not just one streamlined thing. I mean, you can think about it that way, but it has branches that come off of it. So yes, you're initiating this to be going smooth forward for this one visit to make sure everything's good for this one visit to bill out and be reimbursed. But what about past visits? So that's why they have to check those balances and see if they need to ask them to pay on something that services they've already had rendered in the past. That's part of that revenue cycle. So once the patients are all checked in, you know that they're eligible benefits, conversations have been had, they go back to the provider and they have services rendered. And sometimes we can't always predict what kind of services, and oftentimes we can't predict all the services that the providers are going to recommend. They need to see the patient. They need to examine the patient. They need to do their differential diagnosis. And it's at that time that they're going to decide the care plan for the patient who we're going to need to do these tests, these labs, this imaging, this, this, this, and they go from there. And some of that stuff you don't bill out from your clinic because you send them elsewhere to have it done. And then other things you do. So it's one of those things that that provider and the staff involved in that care needs to make sure they're capturing all that information accurately in the chart note and that they're coding for it correctly. This is all going to be in my next video, where I'm going to go a little bit more in depth about things that need to be kept an eye on and making sure that it's recorded in order to get reimbursed. So definitely check out part two of this RCM video series I'm doing. But this first video is really about that front desk, the people who have the initial contact with your patients and making sure that all their information in the patient's profile demographics insurance is accurate, active, and patients have that, you know, expectations from the practice and the practice has presented those expectations to the patient on cost shares. If you have any questions about these steps, please let me know. Please leave anything in the comments below that you want me to know about. If I missed something, if there's something else that you want to share with your colleagues, please don't hesitate. Put that in the comments below, smash the thumbs up button. If today's video was helpful and subscribe to my channel, if you haven't already, thanks so much, you guys to care of yourselves, bye-bye.