Steps in Revenue Cycle Management in Healthcare

Healthcare Revenue Cycle Management (RCM) is the backbone of the healthcare industry. It manages suppliers’ finances and keeps them going on a daily basis. In order to make RCM success, several organizations participated in the process. Here you will see the Steps in Revenue Cycle Management in Healthcare and Revenue Cycle Management Challenges in detail.

What is Healthcare Revenue Cycle Management (RCM)?

Revenue Cycle Management (RCM) is the mechanism in which the entire patient’s medical billing lifecycle is handled by healthcare facilities and practices, from patient scheduling and registration to final payment.

The financial method of obtaining payments for medical expenses to raise money for a healthcare organization is healthcare revenue cycle management. RCM blends administrative details with financial billing information, such as a patient’s personal information, the name of the insurer, and care codes. A standardized billing and coding system is used by health systems to allow efficient payment, enforcement, and clinical processes.

Healthcare RCM Workflow

The workflow/process of the RCM is given below:

1.     Scheduling and Registration for Patients

When they make an appointment, demographic and insurance details may be obtained from patients. Here the revenue cycle begins with an ability to obtain the appropriate information for the next steps of the cycle.

2.     Eligibility & Benefits Verification

Part of the front office staff’s drudgery has to do with screening patients for eligibility and benefits. It can be a grueling and time-consuming procedure when performed over the phone, which saps employee morale.

Modern Medical billing companies in India can automatically check patient eligibility via secure channels through the Internet, ensuring that using dedicated RCM software will speed up the work involved in checking that a patient is entitled to a specific benefit.

3.     Copay / Deductible Collection

It is made easier to obtain the overall copay or deductible before services are provided by assessing eligibility before the patient is in the office.

4.     Patient Visit

Physicians will concentrate on what matters most when the first three steps are done correctly: delivering quality patient care.

5.     Claim Submission

Submitting detailed and timely claims maximizes the received revenue and eliminates delays. Medical billing solutions that take account of the entire revenue cycle of claim submissions right from the first phase help improve the willingness of the practices to receive the full amount of payment.

6.     Payment Posting

The bill is posted and can be charged by your patient after the claim is successfully submitted and reviewed. In this respect, RCM software can not only assist with the ease it provides for producing billing statements. With a’ click here to pay choice, you can also use the system to send messages to patients electronically to enable them to reimburse you more quickly. Electronic Data Interchange offers billing over networks like this (EDI).

7.     Denial Management

Claim denials pose an important threat to the income stream of practice. An efficient denial management mechanism will better remedy denials and recover revenue that would otherwise have been lost.

Revenue Cycle Management Challenges

Managing Healthcare RCM framework of an organization is complex. Here are the top most common challenges are given below:

1.     Lack of visibility into data

Many practices suffer from a lack of data and insights from the revenue cycle, while other practices spend many hours each month scrubbing, importing, and exporting information into the formats and context they need. Proper technology allows for accountability in areas such as physician efficiency, personnel productivity, rejection rates, and other sales cycle indicators that help to enhance financial performance in data-driven decision-making. In general, practices that optimize the reporting capabilities of their current technologies or layer on an additional analytics technology have addressed their data gaps and improved in areas such as precise and full reporting, denial management, and maximized net collection rates.

2.     Tracking Claim

Tracking a claim through its entire lifecycle is another major obstacle to the healthcare Revenue Cycle management software. In order to determine where mistakes are being made, healthcare practitioners should closely track claims processes.

Revenue could theoretically be lost if providers are unable to locate where problems occurred and rapidly correct errors. Usually, providers may receive automatic notifications addressing why payers regularly reject claims for particular procedures or codes.

3.     Data analytics

The top spot for 2018 was also data analytics, as the value of optimizing data for enhanced patient outcomes and healthcare management remains vital to every company or practice’s effective revenue cycle management. several providers also use big data analytics and healthcare IT solutions in India to run effective revenue cycle management systems for healthcare.

4.     Staff Training

Unqualified health facility employees are one of the most significant obstacles in the revenue cycle management of hospitals. Providing the staff with preparation (both clinical and non-clinical) will help you with–

  • Retaining more staff as they establish loyalty to your practice
  • Boosting the morale of the workers
  • Enhance job-competency
  • Providing the patient with greater value
  • Maintaining cash flow

It is easy to gauge the state of a good medical organization by how consistent their cash flow is. If the receivables from the accounts are cleared on time, then the activities go smoothly. If not, they need to step up so that their bank statements soon represent the cash they need to earn. It is suggested that you take the advice of hospital revenue cycle management service providers during times like these.

Last words:

Dreamsoft4u Pvt. Ltd. is the software development company in USA that provides various healthcare IT solutions. Dreamsoft4u Pvt. Ltd. aims to deliver cutting edge Software Development Services according to our clients’ requirements to straighten out complex issues throughout their digital evolution journey. Our experienced team of developers delivers fully-functional and scalable solutions by using latest methods, tools, and practices.

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