Like we know, revenue cycle management (RCM) is generally used by hospitals and healthcare facilities to track each and every detail of a particular patient from appointments, rescheduling dates to the entire medical billing process. The RCM software includes the whole financial and administrative details like the patient’s name, the name of the insurance provider, and many other personal pieces of information too. The RCM services also include what kind of treatment the patient is getting along with the patient’s full medical details.
The main component of the revenue cycle management services is communicating with health insurance company providers. Immediately after booking an appointment for the patient, the hospital staff members’ or the physician’s office check the particular patient’s insurance coverage before they visit the clinic. According to ICD-10 codes that are present under the healthcare laws, the payment procedure of the patient gets followed according to the codes.
After this, the care facility or the hospital sends all the ICD and the Current Procedural Technology codes to the patient’s insurance provider to find out what part of the care facility of the patient is covered under the insurance coverage to make the remaining bill accordingly.
RCM Strategy
RCM in medical billing includes all clinical functions and administrative details of a patient and also connects with the patient’s insurance provider as well. What particulars are involved in the revenue cycle?
- Charge Capture: Converts all types of medical services within the billable charges.
- Coding: Lays down the skeleton for code procedures and diagnosis properly.
- Claim Submission: Submits all the claims which are included in the bill to the insurance provider.
- Patient Collections: Collect all payments and balances from the patient.
- Utilization Review: Examine all the necessities of medical services.
- Pre-Registration: Collect all the pre-registration information like insurance coverage and many others as well before they visit the clinic.
- Registration: Collect all vital information about a patient during registration to make a medical record in their software for future use.
- Third-Party Follow-Up: Collect all the payments from the third-party insurance providers.
- Remittance Processing: Apply or reject payments by the remittance processing.
What Are The Best Practices For Revenue Cycle Management (RCM)?
In the healthcare industry, following the best practices in Revenue Cycle Management (RCM) can deliver the right results. There are certain aspects that a healthcare service provider must take into consideration before outsourcing its RCM requirements to any company. Healthcare revenue cycle management starts with booking an appointment in a clinic or hospital to final bill payment. Below are some of the points to consider.
1. Keeping the patient in the center of the process
In healthcare, maximizing the RCM requires better relationship management with the patients. The staff of the clinics or hospitals should give the best patient satisfaction, which helps to build loyalty with patients and their families as well. The staff also have to give both written and verbal explanations about the financial aspects, payment modes, and methods and also what they can expect during their visit. Many people get quite confused with the payment, bills, and services and if they can get good guidance regarding these things, they will also be quite happy with the healthcare services that the hospitals and clinics are providing.
2. Investment in technology
Sometimes it is seen that medical claims are automatically denied after submitting. It happens due to outdated technology. That is why investing in technology and improving the clinic management software is quite important. Automated software can identify any errors during submitting and if there is any mistake, it will alert before submitting. This also helps the staff to find unpaid claims very easily and also helps in getting reimbursement in a lot less time.
3. Collection of patient financial responsibilities
The healthcare revenue cycle management often slows down when a patient’s financial dues are unpaid or paid late. Hospitals and clinics are always at a risk of not receiving the whole payment for their services and for collecting they have to employ extra staff. But unfortunately, almost half of the patients have medical debts and they never pay and due to high deductible insurance plans as basic norms, the system will also not change anytime soon.
4. Automate earlier eligibility and authorizations
Verifying the patient’s insurance coverage during the registration is one of the RCM best practices. Nowadays, insurance providers are becoming quite strict in their systems, and checking eligibility, coverage and other criteria is very important. Automating earlier eligibility and authorizations can help to improve the speed of the revenue cycle, clinical processes and also helps to reduce the amount of time that the staff has to spend.
5. Filing claims on time
Sometimes some providers of healthcare services do not file their claim on time and thus they miss their deadlines too within which they should have filed the claims. Almost all insurance companies give 90 days to file the claims and if the dates exceed they do not allow them to file and thus the claims remain unclaimed, but this practice needs to change. It is important to file the claims on time.
6. Denial Management
If all the above best practices are not followed, this may be the outcome as denied claims. Tracking and looking after the denials is quite important for any hospital. That is why denial management programs are very important to implement. This will lower the increase of cash flow, decrease the denial volumes and also lower the cost of collection rate.
So, that’s all about the best strategies to follow when it comes to the Revenue Cycle Management system. RCM in medical billing is quite a vital part to track all records. Making your staff understand the clinic management software is also just as important. This is where hiring a responsible and reliable RCM service provider like Synergy HCLS can prove to be beneficial for your healthcare business.
