Revenue cycle management is the process used by healthcare systems in the United States to track the revenue and collect the cash from treating patients, from their initial appointment or encounter with the healthcare system to their final payment of balance. This entire process encompasses the identification, management, and collection of patient service revenue, from insurers and patients.
Without a process such as this in place, healthcare organizations are unable to keep their doors open to care for patients. In short, it’s a financial strategy that healthcare organizations use to pay their expenses.
This process begins when a patient makes an appointment for medical services and ends when all the claims and payments from the patient and their insurer have been collected.
Some key components of RCM are:
- Scheduling
- Registration
- Insurance verification
- Authorization
- Financial Counselling
What is Revenue Cycle Managment in Healthcare?
Healthcare revenue cycle management begins when a patient makes his or her appointment to seek medical services and ends when all claims and patient payments have been collected. However, the life of a patient’s account is not as straightforward as it seems.
To start, when a patient arranges an appointment, administrative staff must handle the scheduling, insurance eligibility verification, and patient account establishment.
Pre-registration is key to optimizing healthcare revenue cycle management processes. During this step, employees create a patient account that details medical histories and insurance coverages.
The provider also must complete charge capture duties, which documents services into billable fees.
After a claim has been created, it is sent to the private or government payer for reimbursement. But, healthcare organizations still need to oversee more back-end office task associated with claims reimbursements. This involves payment posting, statement processing, collections, and handling claims denials.
Once an insurance company evaluates the claim, healthcare organizations are usually reimbursed for their services depending on the patient’s coverage and payer contracts. In some cases, claims can be denied for various reasons, such as improper coding, missing items in the patient chart, or incomplete patient accounts.
The goal of healthcare revenue cycle management is to develop a process that helps organizations get paid the full amount for services as quickly as possible.
How Healthcare Industries Improve RCM?
Besides improving your information systems and educating your staff on the ins and outs of managing revenue, there are many more opportunities for improvement. Here are five suggestions to help health systems improve their RCM:
- Trend and benchmark your healthcare data.
- Use DOS to Mine Your Healthcare Data.
- Constantly ask frontline staff for suggestions.
- Monitor all payer contracts.
- Maintain convenient and caring touch points with patients.
Merging front and backend functions, leveraging data, collecting payments upfront, and automating prior authorizations are key to healthcare revenue cycle management excellence.
The challenges of the healthcare industry have always complicated RCM. However, practice and hospital leaders can implement these strategies for lasting healthcare revenue cycle management excellence.
How Billing Care Solutions working with RCM
Billing Care Solutions provide an excellent service in Revenue Cycle Management (RCM) system. Our Healthcare Revenue Cycle Management process facilities to manage the administrative and clinical functions that are associated with patient appointment, scheduling, patient visit, and care services, patient eligibility and benefit verification, prior authorization and referral, chart review and clinical documentation, HCPS coding, charge capture and charge entry, billing and claim submission, claim rejections, self-pay collections, patient payments and patient statements. It also includes insurance payment, and insurance refunds, payment posting and reconciliation, Account Receivable and Denial Management, claim appeal and follow up, write off and closing account procedures. Our dedicated Revenue cycle management professional staff will present you with a real-time assistance program to reduce the administration cost and save time through automation.
Our Revenue Recovery Specialists will provide you comprehensive business consultancy in medical billing and custom Revenue Cycle Management Solutions with digital processes that will reduce manual work and improve your business revenue workflow through the automation process. This approach constantly enhances overall operational efficiency and allows the business to expand its best services to Patient Care.