South County Health

Mat Clerrico

Mat Clerrico embarked on his revenue cycle journey just over a decade ago, beginning in the front-end with scheduling and pre-registration call centers for major academic medical centers.  His experience as an EMR and Access trainer provided valuable insight into the intersection of operational needs in registration and billing with the technical capabilities and limitations of the software. Building on this foundation, he broadened his expertise by moving into the mid-cycle, specializing in pro-fee medical coding. He then progressed to the back-end of the revenue cycle, focusing on billing and clinical documentation integrity.

Through this article, Clerrico highlights key aspects of optimizing and maintaining a healthy revenue cycle in healthcare, emphasizing the importance of continuous education for all stakeholders, from clinical staff to IT on revenue cycle management (RCM) processes.

RCM Education: The Foundation of Success

The most important function of RCM is to ensure that all of the key leaders and stakeholders are continuously educated on the basics and advanced knowledge of the RCM functions of their areas. A sign of a very healthy RCM process is a clinical leader of a unit engaging with Revenue Cycle proactively to inquire about a new service, or optimization to billing an existing service. Once they know levers, they can pull to optimize their areas, they become more perceptive of the drivers of revenue in their respective areas.

The Power of Integration: Technology and Process in RCM

Yes, I strongly agree to the point that using talented partners in the IT department who can act as a bridge between optimization of day-to-day operations and the technical expertise of ensuring that the team is using the EHR to the top of its function is vital. You always start with the process; Is the process/policy optimized? If not, then the process optimization is the first step. If so, then the question should be; Are we utilizing the EHR in the best practice for this process? (And if not, can we engage our IT team and/or the vendor to realize best practice?).

“The more you learn about the inputs like registration, authorization, documentation and coding, the easier it is to understand the output of claims, billing and collections. Genuine enthusiasm and excitement about the entire spectrum of RCM go a long way in establishing yourself as an RCM leader.” 

Clarity and Service: Balancing Patient Satisfaction and Revenue

We've prioritized clarity in our upfront processes, especially when it comes to collecting co-pays, co-insurance and deductibles. I've found that clear communication from the start sets the stage for a much smoother experience for our patients. Equally important is our customer service on the back-end. In my experience, the most effective customer service comes from taking complex billing issues and breaking them down into simple, easy-to-understand summaries. When we do this, patients feel informed, they know what to expect and they understand the next steps. This approach not only improves their satisfaction but also helps us maintain strong revenue capture by minimizing confusion and frustration that can lead to payment issues.

Stronger Together: The Value of Cross-Functional Collaboration

I've found that frequent and open communication is absolutely essential for fostering collaboration and buy-in. Each team should truly understand where the other is coming from.  Sometimes, the best way to achieve this is through practical exercises. I've found that things like process walk-throughs, where teams physically map out a process together, or even "ride-along" in different departments, where team members observe a process firsthand, can be incredibly valuable. 

These shared experiences help bridge the gap between different perspectives and allow the team to work together to identify areas for improvement. When everyone understands the challenges and opportunities from each angle, we can truly collaborate to make things better.

Bringing Clarity to Medical Bills: Eliminating the Guesswork for Patients

Greater clarity of service and expectations from a final bill perspective is always prioritized by patents. One of the most frustrating parts of being a patient right now is the relative uncertainty of what’s going to be billed, how much will the insurance plan cover (and/or deny) and from there, how much will the patient ultimately owe. We’ve made strides with price estimation and price transparency, but there is still more work to be done to make it clearer for patients.

Key Insights to Peers: Master the Fundamentals and Know Your Revenue Drivers

If you’re new to Revenue Cycle the first thing you’ll want to learn are the processes and policies that drive patient revenue at your organization. After all, the first word in RCM is ‘Revenue’ for a reason. The more you learn about the inputs like registration, authorization, documentation and coding, the easier it is to understand the output of claims, billing and collections. Genuine enthusiasm and excitement about the entire spectrum of RCM go a long way in establishing yourself as an RCM leader.