How to Train Staff for Effective Revenue Cycle Management

Thu Feb 15, 2024 by Evercommerce

Revenue cycle management (RCM) affects every part of your healthcare practice. That’s why it’s crucial that all your staff members understand their part in the process.

Front office staff need to know how to check patients’ insurance. Doctors and nurses must know and document the correct codes when they prescribe treatment. Billing staff must be able to properly process claims and follow up on payments.

Everybody has a part to play. The better trained they are on their part, the smoother the entire process will be.

In this article, we’ll examine the ways RCM impacts your practice. We’ll look at how to train staff in the different aspects of RCM based on their role.

We’ll also consider the tech that can help you manage your revenue cycle. Then, we’ll dig into other important subjects like privacy and HIPAA compliance.

Finally, we’ll share tips on how to manage revenue cycle management training. With the right steps, your staff can feel confident they know all the ins and outs.

What Is Revenue Cycle Management in Healthcare?

Revenue cycle management involves all parts of the billing process. For medical practices, the cycle starts when a patient makes an appointment and concludes when the final bill gets paid.

For most practices, RCM focuses on insurance. Your staff ensure the patient has insurance coverage. Then, they make sure the policy covers all the services the patient gets and communicate with the insurance to receive payment.

Privacy and financial reporting are other important aspects of RCM. All records need to meet HIPAA standards. Revenue info is also important for accounting and insight into your clinic’s financial status.

In most practices, RCM teams use software to help make the process faster, easier, and more accurate. Part of revenue cycle management training is teaching them how to use this software.

Here are the stages of RCM that your staff needs to know:

Scheduling. Your staff verifies insurance or payment methods. They take this info from first-time patients. Also, they check the information for returning patients.
Coding. Medical coding staff assign the correct codes to each service. These codes are important for accurate billing.
Verification. Staff check policies to see if they cover the services each patient needs. This step might include contacting insurers to check on coverage.
Claims. Your billing staff submits claims to insurers. This step may include clarifying services and negotiating with insurers.
Payments. Your team tracks payments from insurance and patients. They may need to handle disputes or underpayment.

Accountants handle the record-keeping and reporting parts of RCM. If you have in-house accountants, they’re part of the RCM process too.

Medical staff looking at laptop

How Revenue Cycle Management Training Impacts Your Practice

RCM ensures your practice gets payment for services. This is necessary to cover operations costs and pay staff for their hard work. Revenue also helps you invest in new technology and training.

If your staff understands RCM, they can better perform their role in the process. This benefits your practice, staff, and patients.

Here are four of the advantages of having well-trained RCM staff:

Better patient services. Trained staff can explain insurance coverage to patients. Patients will know what’s covered and what isn’t and be more engaged in their care. Also, they will feel comfortable with the financial aspect of their care.
Healthy cash flow. Good claims processing and payment management provide better cash flow. Your practice can pay staff and cover costs without interruption.
Limit errors and delays. Your team can check insurance coverage and fix errors early. This limits problems that could delay payment. Also, it helps avoid misunderstandings that often cause underpayment.
Increased efficiency. Trained staff members understand their roles. They finish their duties fast, and they are confident the next person knows what to do. Together, a well-trained team ensures fast payment and few delays.

For RCM to work well, each person on your team needs training in their role. Let’s look closer at training for the different roles in your practice.

Revenue Cycle Management Training for Front Desk Staff

The revenue cycle begins with your front desk workers. They collect each patient’s contact information and insurance details.

Front desk staff also collect some payments. For example, when patients pay deductibles or co-pays when checking in at the clinic.

Here are the most important areas to focus on when training your front office staff in RCM:

Correct insurance information collection. Fast payment often depends on having the right insurance details. Trained front desk staff can check coverage and accurately enter details into the records system. Other staff can make billing and service decisions based on policy details.
Organized scheduling. Front desk staff must be able to handle scheduling for the practice. Efficient scheduling is essential for ensuring a steady flow of patients (and the revenue they bring). They must also prevent scheduling conflicts, overscheduling, and overworking providers.
Patient point of contact. Well-trained staff should be able to answer patients’ insurance and payment questions. Then, your medical staff won’t have to answer the same questions and can instead focus on providing medical care.
Privacy. Front desk staff need to meet privacy requirements. Part of this means being trained in the best ways to ask sensitive questions. They must also be able to process patients’ info without exposing it to others in the clinic.

Front desk staff are also often responsible for collecting other information. For example, they can get patients to fill out registration forms. Or they might collect demographic or household data. These stats are vital for medical studies or research.

Electronic health records (EHR) software is the single most important tool for your front office staff during the RCM cycle. They can complete most, if not all, of their tasks using the tools this platform provides.

Training front desk staff on each key aspect of their job as it can be done with your software tools is the best way to set them up for success.

FROM ONE OF OUR PARTNERS: RCM Challenges Facing Healthcare Providers Today

Laptop with billing icons

Training on Healthcare Billing and Coding Best Practices

Good billing and coding practices are essential to a successful healthcare business.

Your clinic communicates with insurance companies using medical codes, so it’s vital that your team knows how to choose the right ones during the RCM process.

Mistakes can lead to insurance companies denying claims. Or payment might get delayed.

Here are the best practices coding and billing staff need to know. Focus your training on these areas:

Learn the latest medical codes. Medical codes like ICD-10 and CPT change. With training, your team can stay up to date and avoid delays.
Practice cross-checking. Coders should be in the habit of double-checking their work. This may mean asking doctors for details on the treatments or looking at medical charts and notes to verify that the codes are correct.
Provide EHR software training. EHR software can help streamline the coding process. Coders can enter info, and team leaders can audit the work for accuracy. Also, doctors can see the records to check them and use the info to track treatments.
Use specific codes. Train staff to use specific codes instead of general ones. This ensures accurate billing and limits misunderstandings with insurance.

High-quality medical billing software can help with coding and billing. For example, DrChrono has features to manage revenue cycles and EHRs on one platform.

Compliance Considerations with Revenue Cycle Management Training

Healthcare laws protect patient information. The protected health information (PHI) includes medical records used in RCM. Your staff must secure this data.

If your team doesn’t comply with HIPPA during revenue cycle management, the consequences can be significant—as in up to $68,000+ in fines and criminal penalties, significant. These laws also cover secure storage and use of PHI.

Here is a closer look at how HIPAA compliance affects RCM:

Securing personal information. Your practice must adequately protect patient info. Your team cannot share PHI and must learn cybersecurity best practices. If hackers enter your EHR system, you could still be liable for not protecting the info.
Authorized use. Health records can only be used for specific purposes. These are billing, insurance claims, and medical uses. Your staff needs to be aware of these rules to avoid unauthorized use and the penalties it could bring.
Patient rights. Your team needs to know how to respond to patients’ requests for information. Patients can ask for their records and even request changes. Your staff needs to know how to handle these requests.

Billing and coding staff should also understand auditing. The Department of Health and Human Services (HHS) audits records for HIPAA compliance. Your RCM team should know what to do when audited and how to prepare in case an audit happens.

Doctor typing on calculator

Outsourcing to a Revenue Management Service

In-house revenue cycle management isn’t the only option for healthcare practices. You can also choose to outsource RCM instead.

Here are three reasons you might consider outsourcing RCM:

A higher clean claim rate. Outsourcing companies use highly trained RCM teams. They ensure a high rate of accepted claims without delays or denials.
Reduced administrative burden. With specialists to handle RCM, your team can focus on patient care and staff development.
Better cash flow. RCM specialists make fewer errors. They’re often able to deal with insurance company queries quickly. This ensures better cash flow for your practice.

A specialized provider can also help deal with compliance issues and audits for you.

3 Ways to Improve Your Revenue Cycle Management Training Right Away

Optimizing revenue cycle management training at your healthcare practice should be an ongoing process. However, that doesn’t mean there aren’t ways you can improve your RCM right away.

Here are the steps you can follow to get started:

Conduct knowledge assessments. Find out what your team knows about billing, coding, and compliance. This will help you decide what areas you need to work on in the future.
Find case studies on RCM training. Look for examples of successful RCM training. See how you can adopt the methods or approaches to teach your team.
Research software and services. Look at EHR software and outsourcing services. Learn about their features and offerings. Then, decide if these options can help you improve RCM processes.