Perhaps your healthcare facility needs to outsource or improve its revenue cycle management (RCM). While healthcare facilities of all kinds are well known for saving lives and treating their patients’ medical and mental health issues, they also need to develop successful policies and processes for staying financially healthy. That’s where revenue cycle management comes in.
For the healthcare industry, RCM is the process healthcare facilities use to manage clinical and administrative functions. These functions are usually associated with claims processing, payments, and revenue generation. RCM also encompasses the collection, identification, and management of patient service revenue. Without this financial process, healthcare facilities can’t keep their doors open. RCM acts as revenue cycle improvement and helps facilities pay the bills and thrive as a company. Contact CodeMax Medical Billing today by filling out our online form or calling 866.471.3267 when your healthcare facility is having trouble with revenue cycle management or claims and billing.
What Is Revenue Cycle Management?
RCM is a financial process that often uses medical billing software. Healthcare facilities, in turn, use RCM to track patient care, from registration and appointment scheduling to the final payment of their balance. It unifies the business and clinical sides of healthcare by combining administrative data, such as a patient’s name, insurance provider, and other personal information, with the treatments a patient receives and their healthcare data.
Maintaining communication with health insurers is a crucial component of RCM. When a patient schedules an appointment, a healthcare facility’s staff typically check the patient’s reported insurance coverage before their visit. After an insured patient receives treatment for a condition and supplies any applicable copayment, a healthcare provider or coder categorizes the nature of the treatment according to ICD-10 codes. The healthcare facility then sends the care summary with current procedural terminology (CPT) and International Classification of Diseases (ICD) codes to the patient’s insurer to see what portion of the care will be covered by insurance. The remainder will be billed to the patient.
Without effective RCM processes, healthcare facilities are unable to provide high-quality patient care. The latter can make sustaining their financial solvency difficult.
The steps of the revenue cycle may include:
- Charge capturing – The details recorded by physicians about an episode of care are translated at this point into a medical claims system for medical billing purposes. Charge capture systems may communicate with electronic health record (EHR) systems.
- Coding – Universally accepted medical codes are applied to a patient’s record by coding specialists. Once a claim is submitted, insurance companies use the codes to determine reimbursement amounts.
- Submitting claims – Healthcare providers send a claim requesting payment from insurance companies based on set rates for each medical procedure code. Accuracy is essential at this point to avoid claims being rejected.
- Communicating with insurers – Billing managers must communicate consistently with insurance companies to determine patient coverage levels and collect reimbursements without errors or denials. Healthcare providers also go through periods of negotiating rates and contracts with insurance companies.
- Collecting payments – After insurance reimbursements are received, healthcare facilities can bill patients for any remaining balance. This often involves helping patients to understand charges and then setting up payment plans for them.
- Reviewing medical service – Healthcare providers often analyze clinical treatment data to find ways to improve health outcomes, lower expenses, and further maximize resources.
What Are the Benefits of Revenue Cycle Improvement?
Many healthcare providers choose to improve their revenue cycles by investing in RCM software or outsourcing RCM services. RCM software can usually stand alone. However, it may also integrate with EHR.
RCM can save medical professionals time by automating appointment and payment reminders, as well as reaching out automatically to insurers regarding claim denials. Some other benefits of an RCM system or outsourced RCM services can include:
- Ensuring proper reimbursement for Medicare patients
- Determining a patient’s insurance status and copay requirements
- Issuing employee prompts to enter details to save on claim revisions
- Explaining why a claim was denied
- Providing opportunities to review revenue shortfalls
Why Is Revenue Cycle Efficiency in Healthcare Important?
RCM is an essential financial process for healthcare and is considered a core component of health information management (HIM). The latter also covers EHR and patient privacy management methodologies.
To run a successful medical practice, healthcare providers must implement efficient and accurate billing processes. Like any company, healthcare facilities need to take care of their bottom line. Establishing core accounting protocols is essential as healthcare reimbursements are increasingly shifting away from fee-for-service payments and going toward value-based care.
Improve Your Revenue Cycle with CodeMax Medical Billing
When your healthcare facility is having trouble with revenue cycle management, our CodeMax Medical Billing team can help. Learn more about how we can help revenue cycle improvement and revenue cycle efficiency today by calling 866.471.3267 or completing our online form.