5 Steps to Supercharge Your RCM for 2025 Success
Meet Sarah, the CFO of a mid-sized healthcare provider. By end of January 2024, her team was already drowning in denied claims, delayed reimbursements, and a mountain of unverified patient data. Their AR days hovered at 52, and the denial rate was a staggering 15%. Sarah knew they couldn’t survive another year like this.
Enter Plutus Health. Through strategic changes focusing on Eligibility Verification (EV), Benefits Verification (BV), and Insurance Discovery (ID), Sarah’s team slashed AR days to 32, reduced denials by 50%, and unlocked an 18% increase in collections.
Here’s how you can do the same.
Step 1: Start with Accurate Eligibility Verification (EV)
Why It Matters:
Did you know that 23% of all claim denials are due to eligibility errors? Missing or incorrect insurance information can lead to costly rework and delayed payments.
What to Do:
- Use automated tools to verify insurance details in real time.
- Validate secondary and tertiary insurance coverage upfront.
- Cross-check demographic details against payer systems.
Results We’ve Seen:
- Reduced eligibility-related denials by 68%.
- Improved upfront collections by 15%.
Step 2: Simplify Benefits Verification (BV)
Why It Matters:
Patients are responsible for a growing share of healthcare costs, with out-of-pocket expenses increasing by 29% over the last five years. Verifying benefits accurately ensures your team collects what’s owed, without surprises for patients.
What to Do:
- Automate BV to calculate patient responsibilities and provide upfront estimates.
- Integrate BV tools into your scheduling and billing systems for seamless workflows.
- Offer clear communication to patients regarding their financial responsibilities.
Results We’ve Seen:
- 20% increase in patient payment collections.
- 10% boost in patient satisfaction scores due to transparency.
Step 3: Master Insurance Discovery (ID)
Why It Matters:
In a perfect world, all patient insurance information would be accurate at the point of care. In reality, 18% of claims are delayed due to missing or incorrect insurance details.
What to Do:
- Leverage AI-powered insurance discovery tools to identify active coverage.
- Conduct batch processing to validate large patient volumes efficiently.
- Use predictive analytics to flag potential discrepancies before they become claims issues.
Results We’ve Seen:
- Identified 99% of active payers through automated coverage discovery.
- Accelerated claims submission by 30%.
Step 4: Broaden Your RCM Strategy
Why It Matters:
While EV, BV, and ID are critical, they’re just the beginning. A broader RCM strategy ensures your team operates efficiently across the entire revenue cycle.
What to Do:
- Implement predictive analytics to forecast cash flow and prioritize high-value claims.
- Automate claims scrubbing and denial management for faster resolutions.
- Monitor key metrics like AR days (DSO), denial rates, and net collection rate (NCR) to identify trends and course-correct.
Results We’ve Seen:
- Reduced AR days to under 35 for most clients.
- Increased net collection rates to 96% or higher.
Step 5: Prepare for 2025 Trends
Why It Matters:
Healthcare is evolving rapidly, and staying ahead of trends ensures your organization remains competitive.
Key Trends for 2025:
- AI-Powered Workflows: Automate routine tasks to free up staff for higher-value activities.
- Patient-Centric Billing: Improve patient satisfaction with clear, transparent billing processes.
- Hybrid Models: Combine AI-driven efficiencies with human expertise for the perfect balance.
Your Free RCM Checklist for 2025
Ready to supercharge your revenue cycle? Download our free checklist to assess your RCM processes and build a roadmap for success in 2025.
Start the Year Strong with Plutus Health
At Plutus Health, we’ve helped hundreds of providers like Sarah turn their RCM challenges into opportunities. Let us help you streamline your processes, increase collections, and reduce inefficiencies.
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