Everything You Need to Know About Revenue Cycle Management

As a healthcare provider, you might be wondering what revenue recycle management is and how it can affect your practice. If you are interested in optimizing the revenue cycle of your healthcare office, read on.

What is Revenue Cycle Management?

RCM is a process used in the healthcare industry to help manage your clinic’s claim processing, payments, and revenue generation. The approach focuses on efficiently managing the patients’ revenue cycle through medical billing software or practice management software. The software is equipped to help a healthcare provider keep track of the claims process. The healthcare revenue process involves everything from determining patients’ eligibility, processing payments, coding claims accurately, tracking claims and following up on denied claims.

Steps in Revenue Cycle Management

An effective RCM process is what your healthcare operation should focus on achieving. You can accomplish this by following all the steps involved in the process. The steps include:

  • RCM Software or A Medical Billing Outsourcing Company

The initial step in claims management is deciding whether to install RCM software in-house or outsource the service from a professional RCM company. In this case, it is easier outsourcing the service with skilled IT professionals to file claims, handle denials and appeals on your behalf. You should do your due diligence to ensure that you work with a highly qualified team to avoid inconveniences.

  • Patient Pre-Registration

This step starts way before the patient is enrolled in the system. It involves collecting a patient’s data, including name, medical history, payer details, and payment mode. The step helps both the patients and the practitioner. It saves time for the patients before consulting with their doctors and guarantees straightforwardness. As for the healthcare provider, they get all the required payment information and can expect the bills to be sorted on time. This helps to eliminate the chances of bad debts for the provider.

  • Patient Registration

The process involves supporting all the information gathered during the pre-registration process. If an error is detected, it is brought to the patient’s attention before it escalates to an adverse problem. It helps ensure that there are no errors that could lead to long delays for providers seeking compensation from payers.

  • Charge Entry and Capture

In this phase, the healthcare practitioner records the services offered to the patient and sends charges to the insurance company. This is a significant step as it ensures that practitioners receive total compensation from their payers.

  • Utilization Management

This is where insurance companies examine the requests made for medical services. They confirm if the medical plan provides coverage for the required healthcare services. Better still, it helps the provider to minimize costs and evaluate if the recommended treatment is appropriate.

  • Medical Coding

Hospitals offer a wide range of pharmaceutical and health services. That is why coding is ideal for translating the written description of healthcare services, processes, personal requirements, and items into numeric codes. The codes help providers to create a map for the processes. Healthcare billers use them to come up with insurance bills and claims for medical practitioners and patients.

  • Claim Submission

Filing and submitting claims is the most crucial step in the RCM process, as reimbursement entirely depends on it. As soon as the medical biller prepares the claims, they are filed with the insurance companies through a clearinghouse. This makes sure that the claims are clean and free from errors. Internally, a practice management software analyzes the operational process of the revenue cycle management. The billing company follows up with the payer to ensure they reimburse on time.

  • Reimbursement for the Services Offered

In this case, the payers match the medical procedures with the charges under their coverage limit. If all the bills are accurate, the acceptance process is smoother and returns maximum reimbursements.

  • Denial Management

For the claims that are rejected, they are resubmitted right after being screened for coding errors. The resubmissions demand keen screening with an eye on the latest coding guidelines. It is then routed back to the insurer with the exact amount of payment expected.

  • Insurance Follow-Up

When there is reduced reimbursement from the payers, the healthcare plan fails to cover all the services. Therefore, this calls for insurance follow-ups to ensure the claims are received correctly. If a provider is not satisfied with the reimbursements, they can adjust the rates the next time plaintiff negotiations come up.

  • Patient Billing and Collections

In the final step of the RCM process, patient balances and obligations are always calculated, and a statement is prepared. All the outstanding accounts are tracked carefully, and payment balances for various patients are followed up.

How can effective revenue cycle management benefit your Practice?

The various parts of the RCM process are implemented to help your practice operate more smoothly while optimizing cash flow. One of the best things about the process is that it helps in improving the verification of patient accounts. This allows for enhanced healthcare and makes for a more straightforward medical process. It can help you streamline processes such as patient pre-registration, payment reminders, and engaging payers concerning claims.

The process also allows for reduced errors and redundancy. It can assist you through the timely detection of errors giving you a chance to correct them quickly. With minimal errors, your practice minimizes or eliminates the costs involved in managing your revenue. It also leads to lower denial rates and expediting payments to your practice. Ultimately, the process streamlines the revenue process allowing you to focus more on delivering the best quality patient experience.

 In conclusion, we cannot deny the importance of revenue cycle management in ensuring smooth healthcare operations. To reap the benefits of this process, you can enlist top-quality services from Collaborative Imaging. We are equipped to tailor the best possible RCM solutions to enhance your operation’s financial performance. Additionally, our expert payer contract negotiators will ensure that you have all the tools needed for a streamlined revenue cycle. After all, we are thorough and dedicated to helping healthcare practitioners provide the best patient care.

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