Healthcare Revenue Cycle Management
- Business

Healthcare Revenue Cycle Management

Know the Basics of Revenue Cycle Management & Take the First Step Towards Success

Regardless of whether you’re the CEO or an administrator of a large healthcare organization, you need to get in-depth knowledge about all the medical and non-medical obligations. Particularly if you are thinking about taking the financial health of your medical practice to the next level, you must have a complete understanding of the healthcare revenue cycle management.

As a healthcare provider,  you’ve heard about some fascinating financial results when the RCM process is managed efficiently. But do you have any idea what the RCM process is in healthcare? Do you know about all the steps involved in getting reimbursements from the insurance companies?

One can’t deny that most medical care providers are still not aware of the efficient management of their billing and coding services. But, no doubt, the primary objective of medical practitioners is to alleviate the suffering of the patients by providing them with standard medical aid.

But think about the fact that: how can you meet your basic medical expenses and keep your healthcare business running smoothly without having a streamlined revenue cycle management in place?

The answer is obvious. Like other businesses, healthcare practices also need consistent cash flow to keep their service standards high and survive in the fast-pacing healthcare industry.

Therefore, it has become crucial to always stay on top of your medical billing services and implement smart RCM solutions to drive maximum revenue. It would be best to keep a balance between the core and non-core functions to make your healthcare facility successful as a whole.

Before taking proactive steps to elevate the efficiency of your RCM process, the healthcare providers need to know why Revenue Cycle Management is Important in Healthcare.

Steps Involved in Revenue Cycle Management

Healthcare RCM begins when a patient gets registered to seek medical services and ends when healthcare providers get completely paid for the services rendered. It may sound simple, but in reality, it involves the following steps:

  • Patient Scheduling and Registration

The billing cycle starts with scheduling the patient’s appointment. Collecting demographics and patients’ information, validating the accuracy of the information, verifying records, then scheduling appointments and getting them entered into the system are the basics of the RCM process.

At the time of registration, the front desk staff is responsible for collecting the patients’ demographic and insurance information, such as name, gender, date of birth, age, mailing address, phone number, insurance ID, etc.

This information is then sent to the back-end staff to process further.  As your front desk tasks are the basics of revenue collections management, you should never hand over the responsibility to register patients to the inexperienced staff. Instead, you must hire well-trained staff to collect error-free information.

  • Eligibility Verification & Prior Authorization

It is the most significant step in revenue cycle management. After scheduling appointments, regular and new patients must be verified for insurance eligibility.

Both eligibility verification and prior authorization should happen before providing healthcare services to the patients. In addition, obtaining advance approval from the insurance companies to pay for a proposed treatment or service ensures that physicians receive payment for services rendered.

The front desk staff can get the required information from the insurance card, phone calls with the insurance company, etc. They should note down the following information:

    • Insurance name, ID, and group number.
    • Name of insured.
    • The effective date and end date of the insurance policy.
    • The status of coverage (Whether it is currently active or not).
    • Verify whether the insurance covers the procedure, diagnosis, or services to be provided.
    • Insurance policy’s limitations.

Accurate insurance verification plays a key role in the optimization of revenue collections management.  Because it ensures the submission of clean claims, which ultimately expedite the reimbursements, meanwhile, inadequate verification of eligibility can lead to claim denials, revenue leakage, and cash flow disruption.

  • Charge Entry

Charge entry is a vital process in revenue cycle management. It is the process of entering important inputs and details about patients’ billing information. It also includes the proper linking of codes to medical services and procedures.

  • Medical Coding

It is a complex procedure that includes the accurate extraction of the patients’  diagnosis, treatments, equipment, or medical services into standard codes.

These codes are important to inform the insurance companies about the health services rendered in any other circumstances that affected those treatments and services.

So, make sure that billers are using the correct codes. In addition, they must use accurate CPT and HCPCS code modifiers to provide additional information about the service or procedure performed.

  • Claims Management

Submission of clean medical claims regularly is the most crucial step of the medical billing process because maximum reimbursements from the payers are highly dependent on submitting error-free medical claims.

In this process, medical billers use accurate codes and other provided information to prepare the insurance claims. Then every information is being checked to make sure that there are no potential mistakes that can result in denied, partial, or delayed payments. Finally, after claims scrubbing, claims are sent to the payers.

It’s pertinent to mention here that the role of medical billers doesn’t end with the submission of claims. They stay connected with the payers to know each submitted claim’s status, either paid or unpaid. If a claim gets denied, they rectify the errors and resubmit the claims to reopen them for reimbursements.

  • Payment Posting

It is the last step of the RCM process, which provides a view on insurance payments in EOBs, payments from patients, and insurance checks from ERAs. It refers to the logging of payments into the medical billing software.

Take Action Now

Once you understand what revenue collections management is in healthcare, the next step is implementing smart RCM solutions, i.e., outsourcing medical billing services. Hiring a dependable lab billing company can help you elevate your healthcare practice’s profit margins without excessive financial and administrative burdens.

Are you looking for a trusted third party to outsource revenue cycle management? Then don’t look further than Medcare MSO. It’s a well-reputed medical billing company in the United States. That has earned the trust of its clients by providing innovative RCM solutions. For more information, could you pay a visit to our website?

Healthcare Revenue Cycle Management

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