Best Practices in Revenue Cycle Management
A strong revenue cycle is central to an agency’s financial health and operational success. However, when it comes to home health, hospice, and care at home, even minor inefficiencies can lead to reimbursement delays, compliance gaps, and unnecessary administrative burden.
Following best practices in revenue cycle management (RCM) is key to long-term, sustainable success. But how do you know if your agency is truly achieving a healthy revenue cycle?
In this blog, we're covering proven RCM methodologies that enable care-at-home organizations to streamline processes, strengthen cash flow, and maintain compliance across every phase—from intake to collections.
With the right insights and structure behind a revenue cycle strategy, agencies can turn their revenue data into a roadmap for efficiency and stability.
At A Glance: Best Practices in Revenue Cycle Management
- Conduct comprehensive pre-claim reviews and audits
- Maintain coding accuracy and compliance education
- Track clean claim rate, denial rate, and days in A/R
- Standardize collections and follow-up procedures
- Use analytics to identify trends and support negotiations
1. Strengthen Pre-Claim Review and Documentation
Every successful revenue cycle begins with accurate, compliant documentation. A thorough pre-claim review ensures that patient charts, authorizations, and documentation meet payor and regulatory standards before care begins.
Teams benefit from implementing pre-bill audits and consistent staff education around documentation accuracy. Maxwell TEC often identifies gaps in pre-claim review processes during rapid revenue cycle assessments—especially where documentation workflows haven’t kept pace with regulatory updates or EMR configurations. Addressing these areas early helps agencies prevent denials and accelerate reimbursement.
How Maxwell TEC Helps
Our consultants perform detailed RCM Rapid+ assessments that evaluate documentation practices, regulatory compliance, and payor requirements. These reviews pinpoint inefficiencies at the pre-claim level and provide practical steps to improve accuracy, reduce denials, and support faster reimbursement.
2. Optimize Billing for Accuracy and Timeliness
Billing is the most visible part of the revenue cycle—and the one that most directly affects cash flow. To sustain efficiency, agencies should align their billing operations with payor requirements and monitor key performance indicators such as clean claim rates and days in accounts receivable.
Key billing best practices include:
- Accurate Coding: Regular education ensures coding aligns with evolving regulations.
- Timely Submission: Submitting within payor timeframes prevents avoidable denials and keeps revenue steady.
- Technology Integration: Automated tools and RPA can simplify data entry, eligibility checks, and submission tracking, improving accuracy and reducing manual workload.
Through our RCM Level 2 reviews, agencies can assess billing performance from claims through payment, ensuring systems, settings, and payor configurations support efficient processing.
How Maxwell TEC Helps
We provide strategic oversight and billing support—reviewing system setups, claim flow, and payor configurations to uncover inefficiencies. Our interim leadership and process improvement recommendations strengthen agencies' billing performance and maintain a steady revenue stream.
3. Strengthen Collections and Cash Flow Management
Once billing is complete, collections determine how quickly revenue turns into realized cash flow. A standardized process for following up on unpaid balances, monitoring payor responses, and managing appeals keeps agencies proactive rather than reactive.
The establishment of structured reviews and the use of analytics to track trends can highlight bottlenecks and payment inconsistencies. Maxwell TEC’s consultants frequently guide agencies through the implementation of these oversight methods—helping leaders gain a 360-degree view of payor involvement and make informed, financially aligned decisions.
Digital payment tools, automated reminders, and patient portals can also enhance engagement and shorten the collection cycle while maintaining a positive patient experience.
How Maxwell TEC Helps
Our team provides monthly revenue cycle oversight—providing executive-level visibility into key collection metrics, aging trends, and payor behavior. This proactive review process helps to resolve issues early, improve follow-up consistency, and strengthen overall cash flow.
4. Implement a Robust Denial Management Process
Denied claims can erode both revenue and staff productivity. Building a structured denial management program allows agencies to identify patterns, trace root causes, and develop long-term solutions.
Effective denial management includes:
- Categorizing and tracking denials by payor and reason
- Conducting root-cause analyses to inform process improvements
- Educating staff on regulatory and documentation changes
- Reviewing trends to proactively prevent repeat denials
During Maxwell TEC’s financial assessments, denial data often reveals the need for refined workflows or updated staff training—small adjustments that can significantly reduce duplicative work and strengthen compliance.
How Maxwell TEC Helps
We identify denial trends through in-depth data analysis, helping agencies implement standardized tracking and appeals workflows. Our team develops practical action plans that address root causes and promote sustainable denial reduction.
5. Use Data to Drive Reimbursement and Rate Negotiations
With foundational processes stabilized, agencies can use data to inform payor relationships and rate negotiations. Consistent analysis of reimbursement trends and operational metrics supports evidence-based conversations with payors while building confidence in financial forecasting.
Maxwell TEC’s RCM consulting services help agencies translate raw data into actionable insight—evaluating payor source setups, contractual adjustments, and unbilled balances to uncover opportunities for improved reimbursement and sustained financial performance.
How Maxwell TEC Helps
We bring analytical insight and industry expertise to help agencies use their data more strategically. From rate renegotiations to payor source analysis, our consulting team ensures agencies have the information and context needed to optimize reimbursement and plan for long-term stability.
Sustaining a Healthy Revenue Cycle
Revenue cycle management is an evolving process that depends on visibility, accountability, and continuous refinement. By applying these best practices and leveraging expert guidance, care-at-home organizations can maintain financial stability while prioritizing high-quality patient care.
Looking to strengthen revenue cycle management at your organization? Maxwell TEC offers strategic RCM services, backed by years of hands-on experience with evolving payor policies. Explore how we enable care at home for revenue cycle efficiency.
Empowering Impactful Change Through Expertise
Care at home requires a nuanced approach that balances quality and agility. Maxwell TEC provides strategic consulting services rooted in decades of industry experience and tailored to the realities of home health, hospice, and home care.
Whether it’s conducting operational assessments, supporting your next merger or acquisition, guiding interim leadership placement, and everything in between—we work alongside your team to solve today’s challenges and prepare for what’s next. Maxwell TEC consultants don’t just advise; they roll up their sleeves and drive measurable progress for your organization.
Learn more about our consulting services at maxwelltec.com, or connect with us at sales@maxwelltec.com to bring expert strategy into every phase of your care delivery.
This blog was originally published as "Best Practices in Revenue Cycle Management" by Harper Dion on June 6, 2023, for Maxwell Healthcare Associates. The Maxwell TEC editorial team has since updated this article to ensure accuracy and relevance.
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