“Take steps in the right direction and lead to an effective RCM”
One thing healthcare providers and hospitals cannot forget in their noble profession is generating the value of their services. This value is the reimbursement that they receive after rendering treatment and procedures for various ailments.
As insurance companies play the middlemen between medical services and revenue, the task of earning adequate reimbursement becomes chaotic.
“Revenue Cycle Management”, this term closely relates to keeping everything in check and preventing reimbursement delays. With RCM coming into play, healthcare providers are able to organize the process of medical billing to reap better results.
This blog is an overview of revenue cycle management and how it helps healthcare providers and practices enhance medical billing and coding. We will also understand different ways to optimize revenue cycle management, and its significance in achieving financial stability.
Describing Revenue Cycle Management
One can simply put RCM as a process of collecting revenue through various steps. These steps originate with the entry of a patient and end with the reimbursement of rendered medical services. It is a cycle of administrative activities necessary to attain the financial goals of a practice.
When patients enter a medical facility, they have to undergo some mandatory steps related to their visit and treatment. There are eight steps to the revenue cycle that lead to collection in the end.
Let’s find out about these steps:
Step 1 -
This first step is meant to schedule patient visits by assigning time for initial consultation and follow-up visits. This step is essential for the efficient management of patient appointments. It ensures that care is provided on time and sets the standard for revenue collection.
Step 2 -
Patient Eligibility Verification
When the patient enters a medical facility, some basic information is recorded regarding the visit. This includes demographic information such as name, address, medical history, insurance coverage, etcetera. The patient eligibility verification checks the coverage status to see if the patient is eligible to receive the due treatment. It is a confirmation to ensure that healthcare providers will receive reimbursement for the services.
Step 3 -
Many healthcare services are not medically necessary and such services are not usually covered in the insurance plan. Here, the decision if the service is medically necessary or not is decided by the insurance company. Getting the approval is called pre-authorization so that a healthcare provider can get reimbursement for the service.
Step 4 -
Once a patient undergoes treatment, the medical services are translated into appropriate medical codes to begin with claim filing. This step requires more precision as any errors or mistakes in filing can result in a loss of revenue.
Step 5 -
Submission of Claims
Once the codes are attributed and documentation is done, we move to the next step of submission. Claims are submitted to the insurance company for further processing. After the submission of claims the responsibility of compensating healthcare providers is shifted to the payor.
Step 6 -
The next step after claim submission is insurance follow-up. This step highlights the importance of supervising the status of claims to get timely reimbursement.
Step 7 -
The ultimate step is patient collection. This step ensures that the healthcare providers receive adequate revenue for the services. This step is an attempt to receive payments from the patients for the services that are not under insurance coverage. Here, payments that are a direct patient reimbursement are also collected.
Step 8 -
Denial Management and AR Follow-Up
Even though the last step is patient collection we cannot miss this important step. There are potential chances of errors in the code allocation or claim filing that lead to denials and rejections. The duty of rectifying these errors and resubmitting lies with the healthcare provider. This helps in recovering the lost revenue and improving the financial performance of the practice.
All in all, revenue cycle management is vital to navigate through hospital billing challenges. Proper RCM benefits the financial posture of the practice and prevents errors to protect from revenue leakage.
The advantage of RCM underlines the need to improve the process. As a result, operational efficiency will overpower the billing & coding complexities.
Let's discuss the various methods to optimize the Revenue Cycle Management:
Ways to Optimize Revenue Cycle Management
Taking measures to improve the process of RCM helps ensure that every step from patient entry to payment collection demonstrates quality. Optimizing RCM means optimizing overall operations and being one step ahead.
Here are five ways to elevate the revenue cycle:
Usage of Right Technology
If you are still stuck on the traditional methods of medical billing, then this is hampering your RCM. Most of the claim denials occur due to errors in the claims. Generally, these mistakes are caused by human error.
A way to eliminate such errors and make the process more streamlined is by shifting to technological ways. But that is not it, as a healthcare you must go for something that suits your requirements and delivers great results.
Automating RCM and using appropriate software will elevate the process and enhance the performance.
Automatic Eligibility Verification
As we know, a patient’s eligibility verification is essential to determine the payment status on the basis of the insurance coverage of the patient.
It gives a clear insight into the financial responsibility of the patient and out-of-pocket charges if any. Since this process has great significance, automating this step will lead to better verification. It will also diminish the rate of missing out on important details.
This will enable a system for the identification and analysis of weak areas so that taking further steps becomes effortless. It will also make patients more aware of their responsibility, leading to prompt reimbursement.
Automatic Charge Capture
Without efficient charge capture, healthcare providers will not receive their due reimbursement. What makes charge capture effective is accurate documentation and timely submission of claims.
This is an extensive process and takes away enough time. Automating charge capture enhances efficiency by revamping the whole process of documentation and submission. It also reduces the chances of errors that lead to denial of claims.
Automatic methods make the requirement to stay current with the changing guidelines very easy. It also eliminates the hassle of remembering a multitude of codes. Thus, making the possibility of errors minimal.
Get Professional RCM Services
Revenue Cycle Management is not just one measure, it is a cluster of steps where every step has unique properties. Managing all is challenging and a burden for a lot of healthcare providers.
Tackling the problems related to coding needs a medical billing specialist to prevent the daily hassle of a healthcare provider. Getting help from medical billing services boosts financial performance with solutions for every problem.
Outsourcing partners take care of all the steps of RCM with measures to eradicate the prevailing issues. They use their proficiency to simplify billing and coding. Along with that, they operate to submit clean claims. All their efforts are towards optimizing the process of receiving reimbursement.
Management of Claims and Denials
One more thing that medical billing services take absolute care of is claims and denials. They track the claims at every stage to prevent denials.
They start by ensuring the accuracy of codes and move towards submissions. But if in case there are claim denials, they make sure to analyze mistakes, make corrections for resubmission.
By this, they ensure adequate reimbursement that too on time. A professional medical billing company in the USA plays a vital role in optimizing revenue cycle management and driving the best results.
We have seen ways to optimize the revenue cycle management. Here is a list of the benefits of these ways that lead to a successful healthcare practice:
Key Benefits of an Optimized RCM
Accurate documentation at the front end will lead to error-free claim filing and submission. As a result, the healthcare provider or practice will be able to achieve the desired financial goal.
Increased Revenue Collection
Elimination of errors means smooth workflow and low denial rates. An efficient revenue cycle manages all steps in such a way that achieving the result of maximum revenue becomes effortless.
Quality Care to Patients
When the responsibility of the process is given to an outsourcing partner, the hassle is removed, leaving more time for patient care. Now healthcare providers can devote all their time to delivering quality patient care.
Better Patient Experience
Automated techniques not only reduce the burden on healthcare providers but also make the process easy for patients. This elevates the patient's experience, increasing the chances of timely reimbursement.
Reduction in Administrative Burden
When things are handled technologically this eradicates the administrative burden and simplifies the process.
Choose Unify Healthcare Services
A strong effort towards improving the RCM can lead your practice to productive results. A medical billing company in USA such as Unify Healthcare Services can help you in your journey to maximum reimbursement.
Unify Healthcare Services offers a well-defined process of revenue cycle management for your healthcare facility’s financial success. We have a team of experts dedicated to providing reliable solutions for complexities related to RCM.
Healthcare providers are our top priority, and we make sure to improve revenue collection with best-in-class medical billing services. Our leading-edge RCM services will maximize overall productivity and reduce errors.
Get the industry’s best medical billing solutions, leave the hassle, and enhance billing and coding for an advanced RCM.