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Revenue Cycle Management - Challenges and Factors that Matter

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Revenue Cycle Management - Challenges and Factors that Matter

What is Revenue Cycle Management (RCM)?

Revenue Cycle Management is the process of identifying, collecting, and managing the hospital’s revenue from payers for provided services. Proper Revenue Cycle Management in healthcare is important for a practice in maintaining financial viability while continuing to provide quality care for their patients. It’s important to provide value-based reimbursement with a more holistic approach. Poor billing practices can lead to financial losses putting the motto of providing quality service by the faculty at serious risk.

Challenges in Revenue Cycle Management

A revenue cycle starts when a patient makes an appointment. And there are many steps to be accurately completed for timely payment.

Factors that affect Revenue Cycle Management (RCM)

Despite having no control over the claim review, denials or long wait times, there are some internal factors that the provider has some control over. Areas like productivity, patient volume, and the collection of fees for service can be focused on to improve their RCM.

But there are some potent issues that affect RCM:-

1. Collecting patient payments-

The patient’s responsibility for healthcare costs is growing. If the patient payments are collected during or before their service then the risk of non-payment can be avoided completely. It is a difficult task as many patients can’t afford high cost treatment and are unaware of their financial responsibility.

Patient pre-registration is needed to get the most accurate information about the patient’s medical history, financial responsibility, and insurance information upfront to reduce the claim denials.

2. Fragmented administrative processes-

The priorities of the front and back ends of the office are different. If the process of communication during the patient intake process about the eligibility of coverage is improved it can help with the coordination of payer, reimbursement claims and can also improve payment collections.

The process of revalidating patient insurance information is often overlooked and can lead to denial of eligibility.

3. Eligibility issues-

The process of communication with health insurance companies is important. If the claim process after submission is unmanaged it can lead to pending, rejected or denied claims. The claims should be tracked to know the source of the problem, issues with any specific procedures or codes.

4. Lack of digital workflow-

If the digital workflow is not streamlined adequately, poor quality data and future revenue cycle complications can happen. The healthcare IT infrastructure has to be strong in its foundation to help with RCM and the ability to process reports. The use of an electronic system of working can help to coordinate front and back communication and remove the issue of lost paper documentation effectively.

5. Invest in administrative staff-

Staff that is efficient, skilled and aware about unique requirements of various payers can help in developing an effective billing and collection system. You may need some investment to train the staff about how to use the billing forms, coding, chart documentation, revenue cycle software, etc. Share appreciation and encourage them to contribute value.

Alternately, most practices these days are outsourcing their revenue cycle management to medical and billing companies in healthcare. These companies have experts handling complex tasks, coding and other requirements.

Benefits of Outsourcing Revenue Cycle Management

1. It helps you focus on patients and their treatment rather than on administrative and billing activities which require careful attention as well.

2. You do not need to hire and manage as much staff since the RCM partner will handle the patient check ins and outs, registration, billing, claims etc.

3. The dedicated experts ensure timely reimbursements.

4. They are equipped with latest software and hardware to handle larger billing loads and maintain efficiency, thus minimizing any delays.

5. Revenue shortfalls are improved and an increase is seen eventually.

6. Proper care and attention is paid to following the rules, regulations and maintaining compliance.

7. The professional experts at the billing company improve the reimbursement rates and reduce billing errors.

8. They follow up on accounts receivables.

The benefits of partnering with a reliable RCM company for revenue cycle management services are plenty. Get in touch with us for any questions or a quote.