Revenue Cycle Management (RCM) relates to the method of defining, receiving, and controlling the revenue of payers based on the services rendered. An effective RCM process is necessary for healthcare practices to sustain financial stability and continue delivering quality care to their patients.
Moving towards reimbursement-based and more inclusive patient treatment allows health care facilities to learn how to manage the revenue cycle. Weak collection practises can result in financial losses and potentially threaten the ability to provide quality care. Strengthening the development and streamlining basic operating procedures will help suppliers stay financially viable.
Challenges in Revenue Cycle Management
The revenue cycle starts when the patient gets appointed and concludes with a satisfactory set of payments. There are several steps that should be followed precisely and effectively to ensure timely payment. Possible human errors due to coding complexity, faulty communication, medical billing errors due to duplicate data, and missing or misspelled information can result in lost revenue.
Changing health regulations and reimbursement models can make it difficult to get reimbursements on time. This increases staff time and often requires the appropriate software technology to produce the required reports. Health care providers often work with limited resources. For medical practices to be successful, they often need to focus on increasing administrative efficiency.
Revenue Cycle Management Drivers
Multiple factors affect the revenue of a practice and many of these are internal. However,
some are external and beyond the scope of the practice.
Internal drivers include fees for the practice, procedures, and treatments. This also involves the entire patient base of the practice, health status or disabilities, frequency of treatment, and the willingness of doctors to see patients and offer the required care. Front and back-office workflows and personnel capabilities are also imperative in driving sales.
These drivers require the payment of patients and insurance payers, and they present a much greater challenge. External drivers also provide health regulations and compensation schemes.
Best Practices in Revenue Cycle Management
Despite several major obstacles, following a few best practices maximize reimbursements. It also decreases expenses at each point of the healthcare revenue cycle and allows healthcare practices to better identify, measure, and manage their financial aspects.
Optimize front-office processes
Train the front-line workers to collect all the appropriate demographic and insurance details from the patient during the appointment. Use ‘contact scripts’ to help workers clarify the collection of copays and the different payment options or policies offered to them. Well-trained front office workers contribute to both sales optimization and customer satisfaction.
Insurance eligibility verification
Automating the checking of insurance eligibility benefits both the practice and the patients. It helps avoid claims mistakes and makes patients aware of their payment obligations. Increased accountability helps patients plan their payments and respond quickly when front-office workers receive these payments.
Use and configure EMR templates to capture both clinical documents and data. Remind clinicians to record clearly, thoroughly, and reliably, and set up a review process to help them find areas for improvement.
Integrated EHR System
If necessary, use an EMR/EHR that’s compatible with your revenue cycle management system. You can push the data downstream automatically and smoothly to reduce errors and delays.
Optimizing Back Office
Use technology to automate major elements of the claims submission process. E-remittance can speed up payment turn-around time. Healthcare practices provide an online payment portal that allows patients to make easy payments that were not received during an in-person visit.
Assess and implement software solutions for different aspects of the revenue cycle according to the needs of your practice. The right technological system helps doctors to concentrate on providing quality patient treatment rather than administrative processes. Consider outsourcing the revenue cycle management to medical billing services.
Why Is Healthcare Revenue Cycle Management Important?
Compatible frameworks provide advanced functionality that healthcare organizations need today. The greatest advantage of a coordinated system is the ability to deliver everything that is needed to handle medical billing from a single vendor. Blending these two frameworks makes the challenges simpler to deal with. This enables the practice to provide better patient care. In addition, it also makes reception and management more efficient.
Ultimately, all practices are looking for increased income and reduced expenses. Healthcare revenue cycle management is the way to avoiding all payment problems. While every practice has its own unique medical billing needs, consistency is important in all aspects to boost revenue. Healthcare companies may explore potential efficiencies provided by electronic transactions and workflows with the right revenue cycle consulting.
Healthcare practices embracing automation and technology are ahead of those that are still stuck with time-consuming manual tasks that do not achieve the desired results, i.e, maximum pay for services provided in a timely manner.
It is very important to determine the need for robust and efficient revenue cycle management systems.