Does Your Healthcare Organisation Need Revenue Cycle Management?

A successful medical practice requires several factors to operate. Unquestionably one among them is revenue cycle management. Using a comprehensive healthcare revenue cycle management program, healthcare professionals can make sure they are quickly and adequately paid for their services. There is no question that it will benefit the service provider and the patients who utilize it. However, it would help if you first looked at the necessity for compensation before considering RCM’s goal.

Here, we’ll focus on outlining what Revenue Cycle Management entails:

Controlling the medical industry’s revenue cycle

Administrative and clinical management techniques are used by businesses that manage the revenue cycle. For instance, the operation will begin when a patient calls the doctor to schedule an appointment. The cycle is finished after all visits and treatment costs have been covered.

Revenue cycle management seeks to identify and eliminate friction points in the provider’s revenue cycle. For instance, with good revenue cycle management, a service provider may maximize claim reimbursements and boost sales.

How to manage the revenue cycle?

Healthcare revenue cycle management involves several phases. To ensure effective customer management, each procedure must first be carefully handled. This is how the process starts.

Verifying eligibility and preapproval

When a patient makes an appointment, the healthcare practitioner collects information to build a patient account. This entails obtaining the patient’s insurance information and determining their eligibility for coverage.

Charge capture and coding

The charge capture process transforms patient services into billable expenditures using medical codes. Insurance companies also use these codes to figure out how much to compensate.

Bringing claims

The insurance company is notified of the claim when the patient’s treatment has been accurately coded. RCM oversees and monitors the claim to ensure timely submission.

Payment stubs

When a patient’s claim is approved, the insurance company pays the patient following their eligibility. If a balance remains after insurance reimbursement, the practitioner must contact the patient to collect unpaid bills.

An analysis of medical services

Comprehensive revenue cycle management is promoted for the healthcare business and allows for the analysis of clinical treatment data. Service providers may identify where errors occur and develop cost-cutting solutions using data analysis.

RCM challenges

Healthcare organizations must have effective revenue cycle management to be viable and profitable. It’s more crucial to generate money and use it to improve the caliber of professional treatment, though. Because of this, the healthcare industry is beginning to leverage artificial intelligence and robotic process automation to manage its revenue cycle in the contemporary digital era.

Workflow automation eventually improves accuracy, increases collections, and raises overall profitability. Nevertheless, several RCM practices still need improvement, especially in specialized healthcare.

Since healthcare debt collection services are exclusive to the specialization, the revenue cycle process calls for specialized resources with specialty-specific competencies. RCM intimidates the vast majority of healthcare organizations. More significantly, consider how frequently laws are changed.

Bringing the proper charges

Charge entry is one of the most critical processes in the medical billing process. Following the charge schedule and the accompanying medical codes, the correct amount is assigned to a patient account. The charge entry process determines the payment given to the doctor for the services rendered. Also, charge entry is critical to all cost accounting processes and financial benchmarking for the practice to be fairly compensated.

The charge entry process is more challenging due to the specialized ecosystem, which includes multiple specialists in value-based care or bundled payment systems.

Accurate medical coding

Coding for a healthcare provider is one of the complex processes in revenue cycle management. The ICD-10 criteria for specialized healthcare are rapidly changing. Thus, coders must stay current on all relevant details of best practices. Income leakage might be brought on by insufficient knowledge and bad coding. Payment issues brought on by frequent rule changes may be handled when you hire an offshore revenue cycle management company to handle your specialty coding needs.

A/R Management

Account receivable criteria for each specialty must be followed while managing the A/R. A group of dedicated denial management and accounts receivable professionals may maintain accounts receivable days in fewer than 30 days. Based on claim denials, you may build an iterative feedback loop for coders and doctors. When there are significant backlogs, the emphasis may be shifted to denial prevention, and situations can be removed.

Credentialing

Doctors must have credentials with the payer’s network in order to treat patients covered by the payer’s policies. A doctor’s eligibility to provide clinical care is confirmed through the credentialing process. The payer also certifies that the medical practice conforms with the standards for rendering clinical therapy.

Future healthcare revenue cycle management

A successful revenue cycle takes a lot of effort. Because the stakes are so high, practices always look for revenue cycle management strategies to increase profits and save costs while putting patients’ needs first.

Here, healthcare experts are prepared to adopt cutting-edge digital healthcare trends. Healthcare workers may present new technology to patients through conversation, which will probably excite their interest. Customer service outsourcing also reflects top sales cycle trends:

Practice and patient payment adjustments

Managing payment volatility is a crucial topic in revenue cycle management. So the cutting edge of RCM advances includes patient invoicing, using credit cards on file, and payment plans.

Another trend that will emerge is the use of payment plans, which have long been standard in the retail industry. Cost-related reasons are now causing adults in the US to put off or forego seeking medical and dental care. In this case, hospital revenue cycle outsourcing can help these practices get their money back.

When patients can pay for the necessary care over time, they receive it. Additionally, because practices are paid more rapidly and outmoded payment collection and appointment scheduling systems are changed, it provides patients and medical professionals more time.

The notion that a patient is a “payer” could persist. As a result, providers could need assistance with prompt, patient debt collection services.

Automation is improving

The process may be sped up by automating the revenue cycle and providing top-notch patient care. Additional effects include quicker prior authorization and claim processing, fewer denials, and more revenue. Additionally, administrative tasks that cause stress are eliminated when the revenue cycle management strategy is automated.

As automation advances, hospital revenue cycle management services may utilize robotic techniques to complete tedious tasks. In the future, automation will play a significant role in healthcare revenue cycle management. It may make health information more accessible and give doctors and patients more daily hours.

For instance, procedures for invoicing, arranging appointments, and processing payments are excellent candidates for automation, which offers benefits such as more direct data interchange between necessary parties, a more extensive patient base, and improved patient communication.

Patients may even switch doctors for a better digital experience as practices gain necessary administrative time due to patients using these technologies. By automating operations, healthcare organizations may save time and money. Downtime and operational costs can both be reduced. Eliminating time-consuming tasks for patients and staff results in significant workflow benefits.

This type of response may be seen on the portal along with most solutions to patients’ common billing questions. Personnel may also spend more time and effort responding to customer support inquiries.

Using a committed team and a remote workforce

Fewer employees are practicing more to learn. However, as new technology develops and patients become more informed customers, practices should continue to exercise caution when using revenue cycle management strategies. This entails being informed of current healthcare revenue cycle management trends and being prepared to help.

Revenue cycle teams are not immune to the negative consequences of workforce shortages in the healthcare industry. The healthcare industry is the second-largest sector impacted by the Great Resignation. If attrition rates increase, revenue cycle teams must adjust how they function.

Efficiency is a critical tactic that employs the fewest personnel and minimizes repetitive tasks. However, managing a small workforce has always been challenging because many formerly supervised tasks may now be handled automatically.

Remote employment has become an alternative as more workers express unwillingness to work on-site, and more patients choose virtual appointments. This shows that telemedicine continues to set the standard for healthcare provision.

Wrapping Up

The capacity of healthcare service providers to integrate the most up-to-date clinical technology, patient contact tools, and payment methodologies will primarily depend on the financial viability of their organization.

Your coworker in improving the healthcare organization’s financial health may be an RCM service provider with expertise in a particular field. Healthcare revenue cycle management increases provider remuneration while reducing the time required for administrative and clinical duties. This necessitates investing more time and resources in the patient’s treatment.

Collaborating with our experts ensures you have all the resources required for an efficient revenue cycle. The best alternative is a long-term, skilled, thorough, dedicated helping hand.