Healthcare revenue cycle management is a financial process used by hospitals and other healthcare providers to manage claims processing and improve revenue. Insurance claims are rejected for all sorts of reasons, and the claims process is often not straightforward. Medical revenue cycle management simplifies the process, reduces mistakes, prevents errors and streamlines the overall claims process. To understand the importance of revenue cycle management, we’ve put together this helpful guide.
What’s involved in Healthcare Revenue Cycle Management?
Revenue cycle management starts when a patient books an appointment and ends when all claims and payments are collected. Collecting patient data; names, address, and insurance is a vital and essential part of the revenue cycle. All administrative and clinical processes that involve capturing, collecting and managing patient data are part of the revenue cycle.
What are the benefits to Revenue Cycle Management?
There are apparent benefits to revenue cycle management, such as an improved bottom line. The full benefits of RCM to staff and patients are far-reaching and include:
- Fewer claim denials which save your practice time and money.
- Faster processing of claims which speed up the revenue cycle.
- Pre-checking patients for eligibility and benefits for increased positive cash flow.
- Fewer frustrations for patients which lead to higher patient retention rates.
- Fewer coding and billing errors, resulting in higher productivity.
- Staff spend more time focused on patients and less time on administration.
Are there challenges with Healthcare RCM?
Healthcare revenue management is, by definition, a challenge. Insurance companies don’t make dealing with claims straightforward, and even the most competent staff can make simple human errors. Duplicate claims, coding errors and missing or incorrect patient information can create denied claims. At smaller practices, staff can find it difficult to provide adequate care and attention to patients (which matters in today’s service-driven world) and find time to carefully input claims in a timely manner. Coding and compliance changes mean staff are continually having to keep up with the latest updates. Since the onset of the coronavirus pandemic, medical claim denials have risen by 11.1% which shows how thinly stretched medical providers are at this time.
What is a typical Healthcare RCM Workflow?
From start to finish, a typical RCM workflow will include:
- Demographic and insurance information is collected during appointment scheduling.
- Eligibility verification and prior authorization check that the patient’s insurance is valid.
- Patients attend their appointment and undergo treatment and services.
- Clinical documentation that payers may require is captured.
- Charge capture entry translates documented services into billable charges.
- Proper coding of diagnoses and procedures ensures accuracy and maximizes revenue.
- Claims are submitted in an accurate and timely manner.
- Payment is sent to the patient or insurance. Payments may be received at this point or;
- A claim is denied. Errors are fixed, and claims are resubmitted to recover revenue.
- Run reporting on financial data, and KPIs to see if your systems are optimized.
What Challenges Are Commonly Seen in Revenue Cycle Management?
If you want to bill an insurance company as an in-network provider, you must go through the credentialing process. Applying for credentialing is often complicated. Bikham Healthcare can set you up with provider credentialing services so that you can apply for inclusion in their provider panels and bill an insurance company as an in-network provider. Their research ensures they include a diverse range of popular, effective insurance providers. They can help you submit a participating request to your chosen health plans using their specified credentialing application process. Once approved, they can help you with understanding your contract for participation. Bikham works with a wide range of providers and can negotiate the best rates to maximize reimbursements.
Get help through all stages of the credentialing and the insurance contracting services process, including:
- Reviewing the language of your participating provider contract.
- Explaining the responsibilities of participation.
- Ensuring you get the best possible reimbursement rates.
How Do You Optimize the Healthcare Revenue Cycle?
There are several ways providers can optimize the revenue cycle. Start by making it easier for patients to understand how much they owe. Price transparency before they arrive for their appointment, at the time of service, during claim submission and post-surgery means patients know exactly how much they owe and won’t be in for any nasty surprises.
Allow for flexibility by setting up payment plans for patients with large bills. As healthcare increasingly becomes a service-based industry and patients seek high-value care, providing transparency across the billing cycle will become more important.
How Can Practices Use Technology to Improve Their Revenue Cycle?
Technology can be used to improve the revenue cycle for patients and practices. With the right software, practices can give their patients faster reports, accurate benefits checks and online conveniences they’ve been asking for. A patient can understand the charges, payer payments, adjustments and their responsibility clearly.
The right revenue cycle management team can set up the above while also reviewing your financial data to give you a comprehensive analysis of the key factors, pain points, and bad debts that your business is struggling with, along with personalized optimization solutions.
Where Can I Learn More About RCM?
Bikham Healthcare offers a complete end to end revenue cycle management service for healthcare institutions looking to improve their revenue processes. With years of experience in credentialing, and denial management, they provide RCM services from claims submissions and payment tracking to eligibility verification services and answering patient billing calls. Contact them to get started on your revenue management journey.
