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Every day, more and more physicians, hospitals, private practices, and large healthcare systems are making a switch from fee-for-service to value-based care. 

From the moment a patient calls in for an appointment or steps foot into a clinic or hospital, he/she enters that establishment’s management procedures. Without a proper management system, you can end up having expenses that exceed your revenue.  

This is where the implementation of Healthcare Revenue Cycle Management comes in. Healthcare Revenue Cycle Management is the financial process for managing administrative and clinical procedures.

Have you come across bills with errors, or had appointments swing from under to overbooked in an instant? It might be time to optimize your healthcare revenue cycle management. 

In this article, we’ll discuss five ways in which you can optimize your operational procedures:

  1. Upgrade your Billing System

When it comes to upgrading your billing system, the one thing you have to keep in mind is convenience. 

People seek convenience for every product and service that they purchase. They want to do things the easiest and fastest way possible. Allowing patients to make online payments enables them to pay their bills much more conveniently and quickly.

Chad Sandefur, Director, and Healthcare Analyst at AArete, states the following in regards to enabling online payments: 

“There must be about 40,000 different healthcare apps, and some of those apps allow you to easily find a doctor. In order to anticipate how to make these online payment capabilities put it into the hands of the patient, we have to keep up with that online payment technology.” 

  1. Work with Professionals

Choosing the right system is key to good healthcare revenue cycle management. Your management software is or at least should be as important as the rest of your medical equipment. 

You don’t want to get a cheaper, lower quality product that will not bring you the best return on your investment, right? 

One of the top healthcare revenue cycle management tools out there is the RCM services by NextGen. This system is fairly all-encompassing and can catch things that humans might glance over. With proper usage, this tool can close out payments quicker and reduce backlogging.

  1. Use Data to Track and Analyze Performance

Having separate systems to collect data makes your institution productivity decrease. You have to collect the data separately, then bring it all together in what is usually an excel sheet so that you can look at the overall picture and then make an analysis. This is a lot of time and money wasted.

Collecting data and analyzing it under one single platform is key to maximizing the return on investment.
Did you know that you can save up to $375 Billion a year in unnecessary costs by simplifying the process of billing and financial data management?

Breaking down data silos and collecting information under one single system that also does reporting, will help you make a quick and accurate analysis of the overall performance of your hospital or practice programs and guide you in future decisions.  

  1. Collect Upfront

We all have heard of patients that are frequent flyers and leave without paying. Sixty-eight percent of patients failed to fully pay off medical bill balances in 2016, up from 53 percent in 2015, and 49 percent in 2014. Experts project this to climb to 95 percent this year. 

Constantly calling patients and running around chasing them is not the best approach. It would help if you found a solution that can prevent this from happening. 

First, you need to identify and target patients that have a history of being frequent flyers. Then you must take the proper measurements like implementing credit-card-on-file (with auto-payments). This approach is convenient for the patient and convenient for the institution. 

  1. Automate Prior Authorizations and Eligibility

Health insurance companies have a number of requirements for medical institutions; amongst these are:

  • Prior approval for physician-ordered medical tests
  • Prior approval of clinical procedures
  • Prior approval for medications

All of these requirements often leave physicians with less time to treat a patient and drive up administrative costs. Administrative costs grow if the institution uses manual processes to check prior authorizations and eligibility. 

The solution to this?


The most significant advantage of automation is saving time and resources. Did you know that manual prior authorizations cost an average of $7.50 per transaction, while automated prior authorizations only cost $1.89 per transaction?

Right Processes Save Time and Money!

The healthcare industry is continuously changing, and you must stay up to date with current technological advances to survive. 

Upgrading your billing system, working with professionals, using data to track and analyze performance, collecting payments upfront and automating procedures will help you build a strong healthcare revenue cycle that responds to industry demands.