The choice of the ideal solution for healthcare revenue cycle management for your practice is crucial. In the field of healthcare, RCM encompasses the entirety of the patient’s journey, from making the first appointment to billing for the patient. It is also a part of the duration of a patient’s relationship with the organization.
In the majority of consumer-oriented RCM practices, the procedure is made simpler. For healthcare facilities, RCM is the process of coordinating all clinical and administrative aspects in the clinic. There are a variety of choices.
What Is Revenue Cycle Management?
Healthcare providers have a variety of obligations to take into consideration. One of the most obvious and top priorities is the high-quality treatment of patients. However, managing revenue cycles is also crucial. In today’s complex world of healthcare, having a specific and efficient method helps companies grow and deliver the best results and services to their patients.
The Typical Healthcare Revenue Cycle Includes:
- This stage of the process includes gathering information needed to process claims, perform medical billing, and provide advice to the patient in order to plan for medical expenses. The data that is collected during this phase includes insurance details such as medical history consent forms and personal data like social security numbers and consent forms.
- The assignment of appropriate medical codes to diagnostic procedures is vital in the treatment of patients as well as for making accurate claims for insurance and billing.
- Making claims and submitting them to insurers or government agencies is about ensuring that the information is accurate, attaching documents to support the claim, and adhering to guidelines. After submitting the claim the insurance company or payer scrutinizes and validates the details. They determine the amount of reimbursement.
Dealing with claims that are denied or rejected by the payer and taking appropriate action to appeal or rectify the mistakes that caused the denial. This includes identifying the causes of denial, submitting amended claims, and dealing with any issues with documentation or coding.
Payment posting
Consolidating and recording payment received from the insurance company, the patient, and third-party payers. This involves updating the patient’s accounts with information about payments that includes adjustments and copays as well as deductibles and write-offs.
Receivables (AR) administration
Controlling and monitoring outstanding balances. Logging unpaid claims and following up on non-paid claims or partial payments to ensure prompt and full payment.
- Making patient statements, sending invoices, and coordinating patient payment and collection for services that are not covered by insurance or for the patient’s responsibility, such as co-pays and deductibles, as well as co-insurance.
- Utilizing a comprehensive RCM solution will allow you to gain a complete image of the patient to determine if they require assistance. The staff can assist them by giving them information on their benefits, providing alternatives for treatment, and even assisting them to identify resources, for instance, federal plans that may be appropriate to their budget.
When Should You Look for an RCM Company?
Do you have a limit? When will you know when it’s time to contract with an RCM firm or upgrade your software?
Here are some tell-tale indications that it’s the right the right time to look into an answer:
- A lot of burden on your administrative staff. If your staff aren’t in a position to handle the responsibilities associated with the RCM cycle, or if you’re seeing a lot of denials or errors, it could be an ideal time to outsource or find an effective solution to help your employees manage their workflow.
- Budgetary restrictions. Most of the time, outsourcing is cheaper than employing staff in-house with the same knowledge. If your employees are struggling to complete tasks that are beyond their skill base, outsourcing may be a viable alternative.
- The concern is about compliance. An excellent RCM solution will ensure that you meet all compliance with regulations and keep your practice up-to-date at all times.
5 Things to Look for in New RCM Software
When choosing a healthcare revenue cycle, the business must consider what’s currently working well with their current system in addition to the areas they’d like to enhance. There are a myriad of models, but selecting the right solution for your business will improve efficiency and provide your employees the most effective tools to achieve their goals.
Five important characteristics to look out for within RCM software:
- Reporting and analytics – With reports and analytics, you can gain a more comprehensive view of your practice’s financial condition. With reports such as denial rates, trends in revenue as well as KPIs (Key Performance Indicators) allow you to find areas for improvement and make educated choices.
- Security and compliance Security and compliance – RCM software should be compliant with health regulations, including HIPAA. There must be security measures put in place to (PHI) Protect Health Information from unauthorized access or breach.
- Usability: The system must be easy to use. Make sure that sufficient instruction is provided to ensure an effective implementation.
- Scalability RCM software must be scalable to keep up with the growing demands of your company.
- Customer Support – Be sure you only work with suppliers that provide ongoing, solid customer support.
Selecting the best RCM firm that is suitable for the practice is essential to improving efficiency in your finances and maximizing the revenue cycle process. When you consider these aspects, you will be able to select an RCM system that meets the requirements of your practice.
