Healthcare Revenue Cycle Management (RCM) Important Approach That Hospitals Should Follow

Nov 17

Healthcare revenue cycle management (RCM) is a process that deals with finance, and it is the backbone of the healthcare industry. Hospitals use it to manage their financial operations, including management issues. It is associated with claims processing, payment, and revenue generation, including identification, management, and collection of healthcare service revenues. It manages the finances and keeps them going daily; several organizations are also involved in success.

Furthermore, medical coding is one of the main pillars of revenue cycle management (RCM) systems. It is the translation process of all medical documentation such as patient information, medical history, etc.

The healthcare revenue cycle management (RCM) process starts when patients register and schedule their appointments for a medical reason, and the process ends when they clear their payments. However, this is not as easy a process as it looks.

Revenue Cycle Management Steps

The healthcare revenue cycle can break down into nine steps:

Pre-Registration and pre-authorization

Pre-registration is an initial interaction to gather the information of the patient before registration and medical services. It is a way of engaging patients in healthcare. This information is shared with the administrative staff, nurses, and doctors to facilitate patients better.

Registration

Registration is the record of the patient, which is gathered through the consent of the patient. This record is maintained to meet the medical, financial, and clinical requirements. It is an opportunity to engage patients further and ensure that there should be 100% accurate information. Patient registration can help identify alternative payers such as administration entities.

Charge Capture and coding

This refers to physicians' process to record information about their services into a medical claim for billing. Revenue could be lost without accurate clinical care services because charges are incorrect because of the wrong data entry. It's best if a hospital's charge capture system can interface with the electronic medical record (EMR) to optimize identification and capture of charges for complete billing. Hospitals also should consider centralized charge standards across all departments to improve consistency.

Utilization Review

It is how nurses perform the case studies, review patient records, and check on the patient's information. Nurses speak with the patient; they are the care providers of the patient's treatments. In utilization review, they also give recommendations and evaluate the patient for better revenues.

Coding

This stage involves outsourcing medical services into billable charges and properly coding analyses and procedures, determining payment amounts.

In coding, specially trained staff must identify medical examinations, procedures, and documentation as universal codes in a patient's medical report, such as current procedural terminology (CPT) and the International Classification of Diseases (ICD) codes. These codes are applied to the patient's history, and insurers use them to evaluate the appropriate payment amount for a medical bill. Coders should be trained and certified with ongoing training on current practices to ensure coding compliance, consistency, and accuracy.

Claim Submission

Claim submission involves verifying and cleaning the claims, properly doing them. This step also consists of the claim submission of billable fees to insurance companies. A "clean" claim that gets reviewed and paid by a payer upon initial receipt improves the cash flow and revenue. Consistent, accurate coding can reduce errors that eventually result in claim denials and increase clean claims frequency.

Patient Responsibility/ Payment posting

After reviewing and submitting the claim successfully, the payment is paid by the patient. You can use electronic systems to pay the bills and due expenses of medical bills. Patients' responsibility is to take care of their dues without being delayed. Electronic software like RCM is the most convenient way to pay your bills via Electronic Data Interchange (EDI). Often, patients are confused about their submissions and options, so the providers help them solve their insurance, medical billing, and payment issues.

Remittance Processing

Afterward, reviewing the payments of medical services experts determines that the claim should be denied or accepted. The accounting department is accountable for verifying online through electronic systems regarding the insurance and claim process because electronic systems are easy to manage in less time. Moreover, professionals can also assist with the financial and complex medical billing process.

Benefits of Revenue Cycle Management:

There are many benefits to managing your revenue cycle efficiently. The primary goal is to increase revenue throughout the various processes by first identifying and resolving them.

It will improve the patient's experience by reducing their stress and confusion in the medical billing process.

It also assures that all the processes should be done timely and before the deadline to boost revenue.
It also provides a healthy connection between a patient and medical experience and their finances.
It also streamlines and combines different business processes to increase the cash flow.
It helps maximum recovery for providers through effective, reliable, and convenient processing of claims.
It educates and follow-up with patients throughout their medical journey to ensure they pay their bills.
It enhances and exchanges information between providers, electronic health records (EHR), and office systems.
It comprehends all accessible payer sources from government, state, area, and business projects and institutions.

Some other ways to succeed in Revenue Cycle Management:

Keep Patients Engaged Throughout the Revenue Cycle
Optimization of Revenue Cycle Service Lines through Integration

Integrating multiple revenue cycle management enables them to work better together throughout the medical process. These services line integration can help:

Reduce the burden on patients by clarifying financial debts and excluding irrelevant vendors.

Improve the flow of information and coordination of care among different teams within a health practice.

Better maintain agreements across several administration programs.

It helps in the reduction of payments through faster, efficient, and financial operations.

Leverage Revenue Cycle Technology to Increase Efficiency
Expand Patient Engagement Beyond the Bedside Throughout the Revenue Cycle
Outsource revenue cycle management

A revenue cycle management software merchant can help your organization perform policies and procedures for handling pre-registration, registration, automated coding, and insurance eligibility verification, track claims, resolve denials and manage payment issues. A health IT solutions provider can also help your organization run a successful revenue cycle management model with big data analytics.

Wrap up!

In conclusion, revenue cycle management in healthcare does not just consist of some sectors or workers. It's a whole system that affects patient satisfaction, cash flows, accounts receivable, financial statements, and shareholders.

These problems may include fraud, waste, and abuse, such as unnecessary inspections and procedures. For some healthcare providers, revenue and finances are not only the primary concern. Some may be more focused on the care of the patient.

If you are interested in any revenue management cycle (RCM) services and outsourcing medical billing, you can contact UControl Billing freely. They will guarantee that your business will continue to grow safely. If you wish for any revenue management cycle (RCM) services, you can visit their website @Ucontrol Billing.