Healthcare businesses can be challenging since there are so many moving parts. There is the healthcare side, like taking care of the patient and meeting their health needs, and there is the payment side when treatment is complete. Revenue cycle management is the process that healthcare businesses go through when treating a patient. Here is how embracing this process can help your business run more efficiently.
What Is RCM?
Whenever you go to your healthcare provider for treatment, tracking for the cost of treatment starts. Revenue cycle management, or RCM, is the process of tracing all relevant payments, including insurance, for each patient. One essential part of running a health practice is billing. Correct and efficient billing ensures you are being paid the right amount at the intended time. Getting payment from insurance companies can be complicated, another reason why billing needs to be correct. The steps of revenue cycle management generally include charge capture, coding, claims submission, insurer communications, payment collections, and medical service review. While these steps may vary, most are in RCM.
Charge capture is when information from a physician goes into a medical claims system. Following this, coding specialists put special codes in a patient’s information chart. The claims submission step relies on these codes to correctly determine reimbursement. Communicating with insurers is usually the task of the billing manager. Staying in contact constantly ensures that there is no miscommunication about billing, coverage, and reimbursement.
Next, payment collection occurs after reimbursement. Patients receive any remaining balances. During this step, patients can get help understanding bills and set up any payment plans if necessary. Finally, healthcare providers conduct a medical service review. A provider does a deeper analysis of treatment and potential steps, potential medication. Then they decide if certain medicines or procedures are medically necessary. It can help lower costs for the patients.
However, there are challenges associated with revenue cycle management, including increasing costs for patients and lingering errors with claims submissions. Due to rising healthcare costs, even patients with payment plans and insurance can still fall behind on payments. It is something providers must keep in mind. Also, systems are not infallible, and there can still be claims submissions errors by both humans and machines.
How Can Revenue Cycle Management Help Your Business?
With all of the steps associated with seeing a patient, it’s no wonder why there can be difficulties with collecting reimbursements and payments. However, with RCM, costs are kept down, and patients can receive better and more complete care. Faulty systems can lead to patient chart errors, claims errors, and lost revenue. An efficient, error-free system can help increase revenue and profitability. RCM can assist with reducing human errors and alert users of any issues or denials of claims.
The system can also help with collecting past due payments and reduce the number of late payments. Providers can set up payment reminders to ensure patients are aware of payment dates and the amount owed. Useful emails and texts are sent to patients as well. RCM systems can help providers analyze areas of patient need so they can focus more on any potentially missed issues or trends.
Healthcare revenue cycle management is a necessary set of steps to ensure your healthcare business runs smoothly. Revenue cycle management is usually combined with other systems, like financial systems and patient intake systems. From patient intake to collecting payments, take these steps into account to ensure the patients receive the best care possible. You receive the maximum amount of revenue you can. Understanding how the RCM can help your practice can set you up for success.