Understanding revenue cycle management

Few things help the business of the health care industry and revenue cycle management. Each practice needs to have a successful process to stay financially healthy. So let’s dive into what the issue is.

What is the process? Revenue cycle management is the process in which any practice or health care facility manages the functions associated with claims processing, payment and revenue. It includes the identification, management and collection of patient services, beginning when an appointment is made by a person and ending when payment is collection.

But, there are many steps in between. Some of those include;

• Staff will set up the appointment and make sure they have verified the person’s insurance and establish a payment account. Pre-registration optimizes the revenue cycle management process and creates a patient account to detail medical history and insurance coverages.

• After the appointment is fulfilled and the patient walks out of your office feeling satisfied with his care, the practice creates a claim submission that identifies the treatment received and a code, known as an ICD-10 code, which shows how much the practice should be reimbursed for any specific treatments.

• Once the claim is created, it is sent by the practice to a private health insurer or government payer for reimbursement. But while it sounds easy, it often isn’t. There’s plenty of tasks that also must be handled such as payment posting, processing a statement, collections and claim denial should the need arise.

• After the claim is sent and evaluated, practices are reimbursed for the services rendered. If there is a denial, it often is because of something such as the claim was coded incorrectly, a chart has missing details, or the patient’s account information is not fully completed.

While that is simply an overview, rest assured that there’s much more to it than that. The reason is, RCM is a highly important process. Your practice literally cannot survive without it. And even then, sometimes the payment takes months to be resolved with all the back and forth, especially if you end up with a patient that needs time to fulfill all the payments needed — and that’s just one of the challenges that comes with RCM, including these others;

• Collecting payments before the patient leaves your office can save time and effort when dealing with collections, but many providers see it as a time-consuming task, and is complicated since many patients cannot afford to pay bills upfront during an era of rising deductibles. Finding a balance between pressing for payment and not wanting a patient to switch providers and therefore lose them as a future source of revenue is a tightrope to walk.

• Tracking a claim through its lifecycle is a challenge, and revenue could be lost if providers can’t identify where issues originated and resolve errors.

• Training your organizational staff is a significant time issue and potential pain for practices. Human error is sometimes unavoidable but can significantly setback the schedule for reimbursement should issues like improper coding occur.

Here’s some of the ways that we can help improve your RCM;

• We can help lower administrative costs by taking care of your RCM and decreasing overhead that leads to inefficiency in your organization.

• We can help raise patient satisfaction by making sure that they leave with a positive perception of your practice thanks to your excellent customer service when it comes to billing and insurance resolutions. Satisfied patients are more likely to keep a relationship with a provider.

• Embracing the technological advances of RCM, providers are able to use telehealth technology to deal with high readmission rates. As a result, costs associated with high readmissions rates are lowered thanks to preventing of portion of those that would be deemed unnecessary and would have no real effect on patient care quality other than annoying them. According to one report, a branch of the Veterans Health Administration saved more than $150,000 per year in the first two years after it implemented a laboratory expert system, which helps avoid making common mistakes that lead to high-cost behaviors that would aggravate a patient’s patience.

• By working with us to reduce in-house labor costs and increase efficiency, we can help identify KPIs that determine an organization’s key source of revenue and make continual improvements in services rendered. Any healthcare practice would benefit from carefully examining their financial data to make informed decisions.

Thanks to cloud-based RCM and software, our team of billing specialists and managers can help you thanks to our nearly four decades of experience, resulting in a first-pass claims rate of 98% and an 88% close rate for EHR same-day encounters with nearly 30 million patient visits processed. Get in touch with us today through any of our social media channels and let’s work together so that you can focus on exceptional patient service without billing hassles.