RCM

Mastering the Basics: Your Guide to Revenue Cycle Management

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Healthcare organization is a place where people go in with hope and come out with remedies. It is a source of happiness and well-being for a lot of people.

It is a very noble profession, however, like any other business, it requires money to function smoothly. This is where medical billing plays its part through revenue cycle management.

But how does a revenue cycle management help healthcare organization function smoothly?

In this blog we will go through all the aspects of revenue cycle management and how it can be implemented efficiently to any practice.

What is Revenue Cycle Management?

Revenue cycle management is the financial process used by healthcare organizations to track patient care from the first appointment to the final payment.

It ensures accurate identification, collection and management of revenues from patients. It also ensures that third-party providers are contacted in a timely manner to collect payments.

This decreases satisfaction scores and damages the reputation of healthcare organizations along with loss of revenue. The best way to ensure a continuous and smooth revenue cycle management is to take RCM billing services. There are various revenue cycle management companies that provide extensive services for your RCM.

Importance of Efficient Revenue Cycle Management

Just like any other business, healthcare is also dependent on revenue. Ensuring profitability is a must as it increases financial viability. The collection and management of revenue is very important along with having full visibility.

Revenue Cycle management is the process of managing all revenue-generation functions in healthcare organizations. It needs a proper understanding of how the revenue cycle works from the beginning when the patient first comes, to the end when the organization collects payment.

Revenue cycle management includes all administrative and clinical functions which contributes to capture management and collection of patient revenue.

How Revenue Cycle Management Helps Heathcare Organizations

There are a lot of steps involved in revenue cycle management such as charge capture, coding, claim submission, registration, remittance processing, third-party follow-up, patient collection etc.

Revenue Cycle Management brings together the clinical and business side of healthcare by combining administrative data like

  • Patient name
  • Insurance provider
  • Coverage details
  • Treatment received by the patient
  • Medical history
  • Unpaid treatments

RCM requires creating a patient account which includes data from the initial appointment to the last meeting with the provider.

Revenue Cycle Management & Insurer Communication

Communication between healthcare organizations and insurance providers is a crucial element for RCM. When a patient schedules an appointment with the physician's office, their staff checks the patient’s record for any unpaid charges billed to the patient’s treatment and if the patient is eligible for further treatment.

RCM in medical billing is a time taking and complex procedure that is why it is often advised to take RCM billing services. There are various revenue cycle management companies that provide RCM services and streamline your medical billing process

Once the treatment is provided for any condition, the healthcare coder categorizes the nature of treatment using codes according to the International Classification of Diseases, or ICD-10.

The organization then sends the invoice to the patient’s insurance provider to check what portion of the bill will be paid by the insurance company. The remaining amount is billed to the patient.

Benefits of Revenue Cycle Management

A proper revenue cycle management in healthcare means that organizations can efficiently manage all the functions related with revenue generation. These functions can be clinical or administrative.

An efficient RCM makes identifying and collecting revenues from the patient easier. It is also used to store and manage patient’s billing records which are essential for error free RCM. A lot of providers have created RCM systems integrated with electronic health records for a seamless and smooth transfer of data.

If you take RCM billing services, it saves you a lot of time by automating the process such as filling the forms, checking eligibility, etc. Time consuming tasks such as upcoming appointments, reminding payments and reaching out to the insurers becomes way easy once you hand it over to revenue management cycle companies. If a claim gets denied you will get the reason of denial instantly so you can fix the errors and resubmit the claim.

Save Money for the Provider

A seamless RCM system saves providers money by giving them insights about why the claim has been denied. It also prompts the healthcare employees to enter all the information required for claim processing.

This saves them the need to revise or resubmit claims along with minimizing the probability of denied claims and gives better insights into why a claim has been denied. Rectifying the mistakes becomes easy if the errors are mentioned. This ensures that the providers are reimbursed properly for treating the patients.

Why Is Healthcare Revenue Cycle Management So Complex?

Most healthcare organizations focus on providing excellent care to their patients. This is the ideal thing to do, however, managing the finances is also absolutely crucial if any practice wants to be in business.

It is understandable that healthcare providers do not have the expertise to manage billing efficiently. That is why RCM billing services have become so crucial for organizations.

A lot of providers face challenges in providing efficient and affordable patient care in the ever-evolving medical billing scenario. The provisions, guidelines, and codes go through a continuous process of change frequently which affects claim processing and even leads to denial sometimes.

Reducing unpaid claims, improving point-of-service collections, and efficient coding and billing process, can significantly impact profit margins.

However, one can prevent and reduce unpaid claims to see better profit margins. This task is very difficult if you consider the nature of healthcare.

How Unify Healthcare Can Help You?

Unify Healthcare Services is a trusted name in the field of RCM in medical billing. We provide comprehensive medical billing services to various healthcare organizations as well as private practitioners.

Unify Healthcare Services has trained experts who are well-versed with all the billing and coding guidelines so you can be sure that it will be error-free. We take all the hassle of documentation and verification from your shoulders so that you can focus completely on patient care.

We make sure that you are reimbursed in a timely manner so that you can have your peace of mind while treating the patients.

Unify Healthccare Services envisions to make billing easy and hassle free for every healthcare provider, so every patient gets well deserved patient care.

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