You expect to receive the best care possible whenever you visit a healthcare facility. Errors such as poor billing practices, mixing prescriptions, and wrong test results could cause patients to lose faith in your facility. You could also lose lots of money if you don’t keep tabs on your billing practices. Today, healthcare providers strive to provide holistic patient care while ensuring they are adequately reimbursed for their services. Revenue cycle management helps healthcare facilities identify, collect and manage the revenue they collect from paying customers based on the rendered services. This cycle begins when a patient makes an appointment and ends when the healthcare provider successfully collects payment. This article will dive into everything you need to know about revenue cycle management.
Key steps in the healthcare revenue cycle
The following are the steps in the healthcare revenue cycle from the time a patient makes an appointment till they pay for the services they have received.
The most crucial step in revenue cycle management is pre-authorization. In this step, the healthcare provider captures vital information such as insurance and demographics and determines whether the patient is eligible for insurance. A patient who provides inaccurate information or is ineligible for insurance will experience a denied claim later in the cycle. If all is well, the healthcare provider will then register the patient.
The second step is the charge capture, whereby the front desk worker manually enters patient information and sends it to billing. Another option would be to automate the process to allow the information to flow into the management billing side. Ensure you are correctly coding charges so they can reach the insurance carrier without missing charges.
Submission of the claim
Once you have ensured that you have entered all the charges correctly, the third step would be to submit the claim to the insurance carrier. The revenue team is waiting on the other side to examine the diagnosis code, the CPT code, and the charges in a process known as claim scrubbing. If an insurance claim contains no errors, it will most likely get paid faster.
Next, is the remittance processing stage whereby the healthcare providers receive feedback from the insurance company on how much they will get paid for the services they rendered to patients. Common mistake staff members make is to post their remittances and never look back to confirm everything is correct. A post-and-go mistake could prevent you from making an appeal and getting the reimbursement you deserve.
During the follow-up stage, healthcare providers determine what has been paid and what is yet to be paid. An accounts receivable report can help you determine whether your follow-up piece is broken so you can bring in a consultant to fix it.
Collection of payment
The last step in the revenue cycle management is patient collection. Front desk workers should be trained to collect money from patients before leaving the office. It would also be wise to ensure you send out routine patient statements to accelerate your cash flow and enable your cycle to move better. Ensure you have a clear healthcare price transparency system. This will help members get a quick and accurate estimate of their financial responsibility with online patient estimates directly from your website.
Benefits of revenue cycle management
Revenue cycle management saves time by automating repetitive yet crucial tasks such as scheduling appointments and setting payment reminders. RCM also lets you know why a claim was denied and tracks any unpaid claims. This cycle also detects any errors you could promptly correct and allows you to review any shortcomings in your revenue. Even though the primary focus of RCM is to ensure quality patient care, the cycle ensures the healthcare providers are adequately reimbursed to continue their excellent work.
The role of technology in revenue cycle management
The technological era is with us, and the healthcare industry need not be left behind. Though the Covid pandemic wreaked havoc on the world, it caused healthcare facilities to resort to revenue cycle management in a bid to track claims, receive payments and investigate claim denials effortlessly. Revenue cycle management also seemed like an excellent option since most business operations shifted to remote work. Technology has helped healthcare providers automate repetitive tasks such as scheduling patient appointments, monitoring the billing process, and communicating with paying clients via chatbots. Artificial intelligence has come in handy as it helps healthcare providers investigate why a claim was denied and get to the bottom of the issue.
Revenue cycle management reduces time spent on clinical and administrative functions, leaving you with enough time to focus on providing quality patient care. This cycle also increases the revenue flowing into your healthcare facility, meaning your staff will not be disgruntled due to late reimbursement. We hope you have learnt a thing or two about revenue cycle management and its importance in the healthcare industry.
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