To run a healthcare institution successfully, various factors should be considered and kept in mind. Amongst those various factors, one is of utmost importance, i.e. Revenue Cycle Management. Why is Revenue Cycle Management Important in Healthcare? As far as RCM is concerned, healthcare institutions and medical providers make sure that they are compensated for their services; both in a more rapid and accurate manner.
Before diving deep and understanding why verifying reimbursements makes RCM important for the healthcare industry; let’s discuss what Revenue Cycle Management is.
What is Revenue Cycle Management?
A process used by Healthcare practices all over, that tracks patient care episodes from registration to the final payment is called Revenue Cycle Management. Healthcare providers including hospitals, clinics, and related institutions, often find themselves spending a lot of time on administrative tasks such as scheduling and billing. The work can be time-consuming and tedious, but there is a solution to it, RCM.
Managing a healthcare facility can be complicated that encompasses everything from claims processing to patient billing and reimbursements of medical costs. This iCharge Capturing and Codings where RCM can be helpful. Healthcare RCM is the process of managing the financial side of patient care; from the initial identification of a patient to the processing and collection of their service revenue.
Steps involved in an Effective Healthcare Revenue Cycle
The healthcare revenue cycle is a lengthy process that comprises numerous steps. This means that there are countless opportunities for things to go wrong. Any mistake in the revenue cycle can delay or even halt the reimbursement process for both the providers as well as the patients. To get a better understanding of where multiple errors can occur and how appropriate Revenue Cycle Management can assist to prevent them; let’s look closely at the steps involved in the process of healthcare revenue cycle.
1. Pre-Authorization and Eligibility Verification
One of the most important steps in the revenue cycle is ensuring that the patient is eligible to be seen and has accurate information. It can seem like a tedious step, but it will only lead to more problems later in the process if this step is omitted. That is the reason why Revenue Cycle Management emphasizes completing this step accurately because if the information is inaccurate or the insurance is not eligible, it will lead to a denied claim for sure.
2. Charge Capturing and Coding
When doctors and dentists charge for their services, they use certain universally accepted medical codes to determine the cost to insurance companies. This process is called charge capturing. These codes are how insurers prove the patient deserves money and regulate reimbursement amounts.
Healthcare is expensive; it’s even more expensive when there are coding errors or if the insurance company denies the patient’s claim. Accurate codes are quite essential for avoiding denials. The insurance company may deny the patient’s claim when there is no accurate coding, which can lead to delayed reimbursements.
3. Claims Submission
The process for sending a claim to insurance companies begins with the submission of proper coding. Once the code is assigned, the claim is sent to the insurance company for approval. By ensuring codes are assigned properly, you will be able to track and manage the claim from start to finish.
4. Payment Collections
After the patient’s claim has been approved, the insurance company pays the healthcare professional based on the patient’s eligibility. If there is any leftover balance after the insurance payment, the doctor is responsible to perform a follow-up with the patient to collect the remaining amount of money owed.
When you follow the RCM well, it means handling the patient payment process from start to finish. The Revenue Cycle Management process, if performed correctly and adequately speeds up payment by streamlining claims processing. It also helps to avoid any delays in collecting the final payment by focusing on front-end tasks, such as insurance eligibility and verification.
This also gives patients a clear understanding of their costs early on, so they know what to expect. Each patient will now know from the moment they walk into a healthcare institution what out-of-pocket expenses they have to pay.
5. Medical Services Review
One of the most important aspects of the revenue cycle process is the thorough analysis of clinical treatment data. Thorough data analysis allows healthcare providers to pinpoint at which points in the revenue cycle errors are being made and how to fix them. This will eventually increase the overall revenue for medical providers and will also improve the patient experience.
Merits of Revenue Cycle Management In Healthcare
Effective Revenue Cycle Management is the key to success for healthcare professionals. It has many benefits which serve not only providers but also patients. The ultimate goal of this process is to generate revenue for providers, but other benefits are created in the process, too. These benefits are valuable not only to the providers but also to patients, which makes RCM even more valuable. Some of them are mentioned below;
● Optimizes Workflow to Maximize Cash Flow
Revenue Cycle Management can bring efficiency to the system so that payments are made in a timely manner while minimizing errors and denials. This in turn improves your cash flow. For example, the usage of Electronic Health Records (EHR). They can help to simplify your facility’s workflow by automating the whole process. With a more efficient system, you’ll have more time to care for your patients and meet your goals.
● Streamlines Your Processes For Better Efficiency
Effective Revenue Cycle Management enables hospitals and healthcare centers to streamline all aspects of their business; including communication with patients, payments, and documentation. This makes it easier for them to focus on providing the best care possible.
● Enhances Patient Experience By Improving Touchpoints
The RCM process is an efficient mechanism that helps to reduce billing and coding errors. Not only that, but it also helps to simplify and improve all of the touchpoints involved in the patient experience. This ultimately reduces stress for patients, which in turn leads to higher patient satisfaction. Staff also has more time to devote to the patient, which results in better care for patients and eventually turns out to be better for your hospital too.
● Fewer Claim Denials
Denials are caused by errors in your payment process. That’s why an optimized Revenue Cycle Management gets coding right the first time, a process that dramatically reduces claim denials and speeds up reimbursement.
● Revenue Improvement
One of the key benefits RCM provides is that it helps in revenue generation and improvement. For instance, by streamlining all the tasks involved in the process, you become more efficient and effective as you provide an easier system for your staff and fellow physicians to follow. This leads to faster collections and improved cash flow.
Revenue Cycle Management: Necessary For Healthcare Facilities
No healthcare facility can survive without an efficient RCM. Here are some wonders revenue cycle management can do for healthcare facilities:
● Detecting & Resolving Errors
In this new era, professionals working in the medical industry must be able to precisely detect any errors in the revenue cycle. A good way to do this is by following the RCM support services correctly. Effective management of the Revenue Cycle can help healthcare providers with an important issue: identifying where errors are occurring within the revenue cycle.
In turn, this lessens the chance that a claim is denied due to a technical issue. A key benefit of RCM is that it helps to reduce the number of denials during the revenue cycle which might occur just due to a simple mistake, such as forgetting a piece of information in a patient’s chart or any sort of improper coding.
● Reducing Administrative Burden
One way to help both your employees and your patients is by preventing claim denials. When a claim is denied, a lot of time and energy is spent appealing the denial which can be better utilized for patient care. What is the solution? Preventing the denial from happening in the first place.
RCM makes it easy to focus on the customer experience. Front-end tasks are streamlined to create a more satisfying experience for everyone, meaning both the administrative staff and patients. These tasks include scheduling appointments, intake form completion, and payment processing.
● Avoiding Patient Fraud
Patient dishonesty can also be the source of healthcare fraud. This can happen in two ways:
1. Providing inaccurate information
There is a possibility that patients may lie about their insurance coverage in order to receive the treatment they are otherwise not qualified for. Revenue cycle management is therefore important for detecting and correcting any inaccurate information. With insurance verification, inaccurate insurance information would be easily detected as soon as the patient will appear to receive treatment.
2. Engaging in medical identity theft
Medical identity theft is a growing concern for the industry of medicine, but it can be prevented with early detection. When checking any patient in, healthcare practitioners should monitor for any occurrences of ID theft. RCM starts with verifying that the patient’s information is correct.
Increasing Healthcare Facility Revenue
No medical practitioner wants to deal with technical errors, fraud investigations, claim denials, and the headaches that come with them. Healthcare providers can avoid all of these things by outsourcing a company like GreenSense. As we provide a wide range of solutions such as billing management, fraud detection, and claim denial management which can help doctors spend more of their valuable time on other important concerns such as providing excellent patient care. In the end, providing quality healthcare service is the topmost priority for any medical facility.
RCM: An Important Tool for Providers and Patients
RCM’s primary goal is to increase the overall clinical revenue. Revenue cycle management helps doctors to increase their revenue by decreasing their administrative costs and workload. So this means more money and time would be devoted to the treatment of the patient.
That’s why many healthcare professionals practicing throughout the United States choose to trust GreenSense Billing. Let’s make sure your revenue stream is healthy and robust! Our expert payment contract negotiators will help you understand and manage health insurance reimbursements.
We here at GreenSense Billing are specialized in negotiating contracts with payers. That way, you’ll be aware of having all the relevant tools required to ensure a smooth revenue cycle. Our team of experts is experienced, thorough, skilled, and dedicated to helping hospitals and healthcare institutions all over the States to provide the best, most affordable care possible.
How GreenSense Billing can be a huge help?
1. Trained Billing & Coding Experts
Our team here at GreenSense is fully staffed with billing experts that are constantly up to date on any changes in medical billing codes. GreenSense Billing ensures that your claims are always coded correctly, which will result in the best reimbursement rates. In addition to working with you to perfect your billing cycles, we are also trained on optimizing your claiming process so that you can file your claims at the optimal time, which is essential for maximizing your reimbursements.
2. Claim Scrubbing
Claim scrubbing is the process of removing any errors before you submit your claim for reimbursement. Our team of specialists makes sure to double-check your claims and ensure that they are submitted correctly. This way, we guarantee you that no detail goes unnoticed and every claim is submitted accurately the first time.
3. Claim Tracking
Once the claim scrubbing process is finished, our team of experts track and monitor your claims until they are fully reimbursed. We aim to follow its progress all the way through to make sure your practice is getting the best payout every time. If due to any cause, your claim gets denied; our team of specialized billers will detect immediately and correct any oversights before resubmitting it.
4. Automated Eligibility Verification
GreenSense Billing offers the personalization and technology you need in order to best serve your patients. Our company provides an automatic insurance verification program to make sure your patients are covered prior to receiving services. Along with that, if a patient has a pre-existing condition, their eligibility is verified automatically. By serving your clinical practice with top-of-the-line technology, we simply aid you to avoid eligibility issues. That way, your practice is always protected from any pre-authorization mistakes.