Revenue cycle management services (RCM) deal with instruction’s financial management
process that helps the medical billers and coders track receive, identify, and manage incoming
payments. This is the way to promote the financial revenue stream and collect payments from the
patients and helping to generate more revenue for the physicians for their services.
It is also the process of paving the way between insurance providers and patients. For example,
billing for the patients, collecting payments, and doing reconciliations.
In simple words, Revenue cycle management in healthcare is the purpose of compiling revenue from insurance companies by submitting or re–submitting, in case the claims are denials.
The process of Revenue Cycle management undergoes seven steps
1. Patient Registration
The process starts with patient registration. You have to collect necessary details of the patients
like Email address, home address, and contact details. Date of birth and Insurance information.
All this patient-related information will help you send the billing information. Commonly, you
would have to gather all this information once when patients arrive at your clinic.
Secondly, every time a patient visits, you keep rechecking the patient’s information every time he
sees you.
2. Charge Capture
Charge capture takes place when you send all the patient-related information to the insurance
company. There are two ways to do this.
Automated: The patient information is submitted automatically from the patient documents
during registration. In this method, there are fewer chances of errors.
Manual method: The manual method is not considered old-fashioned because the administration staff collects all the information on the computer and then sends it to the billing
department. The billing companies receive this information and complete the whole process.
Both methods have merits and de-merits, and you may miss out on some information.
Coding
The medical billing process has pre-defined codes that are associated with the aliments. In
addition, codes serve the purpose of certain reimbursements.
Claim Submission
After the charges are coded, the claim is sent to the insurance providers the payments are then
made according to the insurance plans.
When the claims requirements are met, and it the proven that insurance providers are making
payments, but in case of errors, the insurance company will reject the claim and send it back to
the healthcare industry or clinic for correction of errors.
There are a number of ways to correct coding, for instance, you can use the software, or seek
help from RCM company from medical billing companies. All these expert billing companies
will help you out in the submission of claims.
Insurance correspondence
After you have submitted the claims the communication between the insurance provider and the
patients continues. It is considered the patient responsibility.
The sep becomes necessary when the insurance companies take too long to process the
payments. There are stages where the provider may have to suffer payment irregularities. For
instance, an insurance agency may avoid payment completion due to negotiations with the
establishment.
CPT payments and collection
In some insurance plans, the patient must pay a percentage of the total revenue. In most cases,
the insurance payments are measured when the patient first visits the hospital. In these scenarios,
the staff faces difficulty when they cannot collect the CPT in case the patient has left the clinic.
In solution to this problem, the invoice is sent to the patient home address.
Revenue Enhancement
In this process, the whole process is analyzed. The different points are highlighted. For instance,
how long it would take to collect the payments? According to the facts and figures, the process
may suffer some tweaks to receive all the charges quickly.
Some of the main benefits of revenue cycle management are:
Minimize the entry errors
RCM in healthcare is the only solution to all your problems when making more coding errors. luckily, when
you have fewer errors in the coding, you are less likely to get the claims denials.
Timely collections
RCM in healthcare helps you to do the task robotically, otherwise, it would take hours if they are done
manually. You will be able to register more patients with less time spent, and can easily send the
claims to the insurance companies.
Make the process simple and easy
RCM services make your task easier and bring a simple solution to financial management.
Common Challenges in Revenue Cycle management
RCM services simplify your task, but it may mean that it will only eliminate some of the challenges.
There are some common challenges that the refined cycle management process may suffer.
Requires staff training
When dealing with the RCM Strategies, you may have to provide training workshops to your
staff. Otherwise, they will likely make more mistakes that will hinder the overall workflow.
Required Data analysis
The process of the RCM in healthcare Requires data analysis. All the revenue stream is analyzed via analytics
where you count the total reimbursement. Unfortunately, the whole data record will only benefit
you if you know how to interpret it. Therefore, you must train your staff and teach them data
analysis, to help you make the decisions on that records.
Hippa Compliance. Make sure you are not violating the HIPPA rules; if you don’t, you will be
charged with the penalty.
Final Thoughts
Revenue cycle management s part and parcel of your healthcare organization. Therefore, it is
better to have a complete understanding of maximum revenue, otherwise, you will be losing
its importance t the application possible.
