In the healthcare industry, all healthcare organizations tend to follow revenue cycle management to fulfill their mission of providing excellent services to the patients.
Every Healthcare organization focuses on providing the finest services to the patients. Whether those are small clinics, hospitals, or a fully organized healthcare system their core mission is to provide the optimal quality care that is patient-centric. Even though their aim is uncomplicated and quite simple, bringing those thoughts into reality requires infallible strategy and procedures that would let them keep their promise of delivering outstanding amenities.
No matter how big or small they are, every healthcare organization has to balance a multitude number of processes that do not include direct outpatient care. A chief example that falls under this crucial process is called healthcare revenue cycle management.
What Is Healthcare RCM Outsourcing?
Revenue cycle management helps in simplifying the management process of hospitals and other medical institutions. Healthcare institutions provide an extensive list of services which include the registration of patients, scheduling of doctor’s appointments along with medical billing and coding. The process of RCM starts with the patient seeking proper medical care and ends with collecting the required payments.
The financial process of health revenue cycle management is used for payments, processing of claims, and proper generation of revenue. Without the proper healthcare revenue cycle management companies, hospitals would fail to achieve efficacious revenue cycle management.
It is important to understand the fundamentals of healthcare RCM. The process starts with the patient arranging an appointment, after which the managerial staff looks into the scheduling of a doctor’s appointment. Then, the insurance eligibility of the patient is looked into.
Pre-registration plays a pivotal role in the effective management of the revenue cycle. The staff makes sure to generate a patient account that contains all the particulars of the patient’s medical history along with the insurance coverage.
Jotting down the precise details helps in providing the preliminaries that make the billing of claims easier and hassle-free. Creating the submission of a claim is an important step, the healthcare institution identifies the treatments which has been received by the patient along with the correct ICD-10 code. These codes help in providing the correct details about the amount that is to be reimbursed to the individual for certain treatments.
After the creation of the claim, the payer receives it for reimbursement purposes. However, the process does not just merely end here. Revenue cycle management services also include looking into the tasks related to claims re-compensation that includes processing of statements, handling of all the claim denials, posting of payments, et cetera.
After the claim is evaluated by the insurance company the healthcare institutions are repaid for the services based on the patient’s insurance coverage. Sometimes, the claims are rejected for a varied number of reasons including an unfinished account of the patient, an incomplete patient’s chart, and inappropriate coding.
When something is not covered by the insurance company it is up to the hospital to inform the patient and collect the required payment.
How to Make Healthcare Revenue Cycle Management More Effective?
The process of revenue cycle management has gone through a number of different rectifications and improvements that have left many healthcare institutions addled with the question of how they can keep their profit on the higher end of the spectrum.
Understanding certain pre-requisites that can lead to better revenue cycle management is crucial.
1. Investing in the management team
Guiding the team by giving them correct tutelage about data entry, rules that must be followed by the payer, or the tools that make the workflow easier. It is crucial that the management team gets continuous training. Arranging for meetings or permitting open communication is all part of investing in the management team. A good team will lead to growth in productivity.
2. Internet billing
Allowing patients to make online payments leads to effective revenue cycle management. It not only makes the process easier but is also very convenient. Payment mechanisms have come a long way, patients are always looking for convenient ways to make the process of payment hassle-free.
3. Using data analytics to understand the revenue cycle
Making use of financial data along with analytics helps in understanding the revenue cycle through graphs and charts. Monitoring the transactions and understanding the basic performance index helps in getting a clearer picture of revenue management.
4. Continuous updating of the medical bills
Educating the staff about the processing of medical bills is crucial, which ensures that the patients do not get befuddled after their treatment is over. When patients are consistently cleared of their financial bills it helps in avoiding bad debts.
5. Revisiting daily processes
This helps in the flawless management of the revenue cycle. Making sure to update the technological processes on an everyday basis helps in ensuring everything runs smoothly without any hiccups.
Benefits Of Revenue Cycle Outsourcing
Let’s take a look at the benefits that revenue cycle outsourcing has.
1. Bigger revenue with additional cost savings
When you outsource your revenue management it helps in cost savings along with an increase in collection rates. For instance, when you outsource physician billing and coding it helps you in cutting down costs by a significant amount than if you were to hire an in-house medical billing and coding. There are certified coders along with skilled billing staff that understand the necessities for increasing revenue minimizing denials and rejections.
2. Focus on improving patient’s experience
Outsourcing RCM allows you to focus on improving the patient’s experience. Experts handle the RCM which leads to an overall improvement, besides reducing error and also taking the load off of the administrative staff.
3. Dedicated team of billing and coding
The practices of coding and billing are always changing in some way or another, therefore staying updated on those changes minimizes errors, HIPAA violations, and denials. Outsourcing of physicians provides you with a team of well-trained and skilled individuals who are adept in their field.
4. Consistency and transparency
Outsourcing of RCM helps in providing you with thorough and extensive performance dashboards and reports. The analytics help you in keeping track of all the billing performance and operations that do not require any micromanagement. They look into claims management, timely follow-ups, scrubbing, coding, patient statements, appeals, denials.
Outsourcing RCM helps in increasing the cash flow on a daily basis besides keeping all of the processes error-free, systematic and coherent. So, if you are looking to improve the performance and revenue of your company, opt for RCM outsourcing services right away!