The essential role of revenue cycle management (RCM) is unprecedented in the healthcare industry. Although there are many regulatory initiatives that converge with existing demand for faster medical billing services, cycles and cost control, many outsourced medical billing companies face financial and clerical challenges.
It is evident that practices are losing out on valuable revenue collections because of late payments, inaccurate coding and billing , incorrect patient registration information, missing deadlines for claim filing, which ultimately result in denied and unpaid claims. With ineffective revenue cycle management (RCM) medical billing practices, the most prominent healthcare practices may also experience significant losses. Especially when it comes to outpatient services, which can result in up to 25% loss in overall payment revenue collections. Timely collection of patient payments is important for the future success of your practice, especially in the view of high-deductible health plans (HDHPs) and increase in the number of patients. One way to resolve reimbursement challenges for practice owners, is to embrace a new medical revenue cycle management services, practice and models to improve the revenue cycle of their practice.
Timely payments are crucial for medical revenue cycle management services. Patients with HDHPs and health savings have grown over the years and is expected to grow even more. Medical practices that maintain their status quo in terms of medical revenue cycle management services are most likely to experience no increase in profitability.
Advantages of Revenue Cycle Management Process in Medical Billing
It is important to educate healthcare providers and hospitals about the evolving challenges for the revenue cycle management process in medical billing and teach about the best practices for improving revenue collections through medical revenue cycle management services. With proper and efficient revenue cycle management processes in medical billing, healthcare providers will learn how to train employees effectively, apply processes that increase revenue collections and improve upon the overall financial health of your practice. Healthcare providers need to better equip themselves with the necessary medical billing tools to navigate the reimbursement landscape. The revenue cycle management process in medical billing enhances billing functions from the front desk to the back office and helps practice owners to manage their revenue cycle from the initial patient encounter to payment collections and beyond.
In more simple terms, the practice management revenue cycle applies to the several steps that healthcare organizations take to receive payments and maximize revenue for the medical services provided by doctors, physicians or healthcare providers. Today Revenue cycle management (RCM) generally covers all financial aspects of a medical practice.
Generating Revenue through the Best Practices in Revenue Cycle Management
The survival and sustainability of medical practices depend upon its ability to generate revenue. To gain maximum reimbursements from patients; it is necessary to reduce gaps related to technological, administrative and inefficiencies in appointment scheduling. Practice owners can easily achieve this goal with a proactive approach by planning and capturing all the necessary information about patients and copays upfront. With efficient appointment scheduling, the practice management revenue cycle can be optimized to increase revenue by minimizing the number of no shows.
Revenue Collection with Accurate and Complete Documentation
As soon as a patient is called from the waiting room, the clinical procedure begins and lasts from the time when the patient enters and leaves the room. The activity that occurs during this time period is the basis of the practice’s ability to capture revenue and it must be thoroughly recorded and documented. With accurate and complete documentation of services rendered, proper coding and appointment scheduling, you can maximize the revenue generation of your practice. In general terms, back office medical billing functions enables a practice to generate and collect revenue with the best practices in revenue cycle management. Revenue cycle management for physician practice includes billing, posting, accounting, collection, and finally reimbursements, which is the last step of the revenue cycle management for physician practices.
How is Medical Practice Revenue Cycle Management Different from Traditional Billing Services?
With free traditional billing service care delivery models, billing is often regarded by tasks and function related duties, which are performed in the back office. It is not viewed as a shared responsibility between the front office, back office, and clinical staff. Today, with the integration of revenue cycle management, medical billing services have evolved and matured to reflect upon a clinically driven practice management revenue cycle that proactively addresses reimbursements and payments the moment a patient enters through the door of the practice. In healthcare revenue cycle management back office, front office, and all clinical staff play an important role to maximize revenue generation.
For the practice management revenue cycle, it involves conducting eligibility verification before the patient arrives in the office. The practice management revenue cycle, continues with the financial aspects of medical billing, which leads to clinically driven revenue cycle management (RCM). Revenue Cycle Management adopts an overall proactive approach for patient health including appointment reminders, along with medical service and clinical procedure reminders that may be required to maintain or control a patient’s chronic condition, such as diabetes or high blood pressure.
Revenue cycle management practice methods include accurate documentation of patient information; from the beginning point of registration until the clinical documentation process. A single gap or mistake in patient information data can significantly impact the whole revenue stream.
Learning about the Best Practices in Revenue Cycle Management
If the front office staff is unable to get all the related patient information for the payment process or fails to verify eligibility, then the subsequent effects can cause significant billing delays or irreversible claim denials. It is important to have proactive awareness among back and front office staff as a lack of proactive outreach between staff members can lead to workflow inefficiencies.