RCM process can be improved by working on these areas

 Charge Capture Accuracy:

a. Regular charge reconciliation

b. Detailed charge description master review

c. Custom charge scripting. 

Using:

Custom charge macros

Custom charge forms

Custom charge templates

d. Charge capture audits

e. Charge capture training for staff

Claims Processing Speed:

a. Claims editing software

Use of:

Claim scrubber software

Claim validator software

Claim editing software

b. Automated claim submissions

c. Pre-authorization management

Parts:

Pre-authorization request submissions

Pre-authorization status tracking

Pre-authorization appeal management

d. Claim status tracking

e. Claim denial management and appeals process

Denial Management:

a. Denial tracking and reporting

b. Root cause analysis of denials

c. Appeals management

d. Re-billing of denied claims

e. Denial prevention education for staff

Revenue Optimization:

a. Accounts Receivable (AR) aging analysis

b. Contract management and negotiation

c. Payment posting and reconciliation

d. Charge lag analysis

e. Revenue cycle dashboards and analytics

Improved Workflows:

a. Streamlined charge entry processes

b. Integration with other systems

c. Automated charge capture and coding

d. Physician documentation improvement

e. Real-time claim status tracking and monitoring.

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