The revenue cycle begins with billable charges and ends with service reviews. When we talk about the revenue cycle, we mean the specific steps that make up the billing process. Revenue Cycle Management (RCM) is a process of examining your workflow to determine ways it might be possible to reduce the amount of time between providing a service and receiving payment. Reach out to CodeMax today at 866.471.3267 to speak with a trained representative who can help you better understand the value of effective RCM for healthcare consulting services.
The Revenue Cycle
Depending upon whom you ask, the revenue cycle has around ten steps.
- Patient Registration
- The initial onboarding process for a new patient, which includes obtaining important information about demographics
- Financial Responsibility
- You want to know which services will be covered by a patient’s insurance and which services will be out-of-pocket expenses so that the patient is aware.
- Charge capture
- Turn medical services into billable charges
- Claim submission
- Submit claims for billable fees to insurance companies.
- Proper coding of diagnoses and procedures
- Patient collections
- Determine patient balances and collect payments
- Collect pre-registration information (for example, insurance coverage), before a patient arrives for their procedures
- Collect patient information during registration that creates a medical record number that allows you to meet regulatory, financial, and clinical requirements
- Remittance processing
- Apply or reject payments through settlement processing
- Third-party follow up
- Collect payments from third-party insurers
- Utilization review
- Examine the necessity of medical services
- Determine if reviews or other feedback should impact workflow
The Benefits of Effective Revenue Cycle Management
Revenue Cycle Management (RCM) systems can save providers money by explaining why claims have been denied. An RCM system can cut down on denied claims by prompting employees to enter all the information required for claims processing. This saves them from having to revise or resubmit the claim and gives providers better insight into why specific claims have been denied, thereby enabling them to rectify the issue. This also ensures providers are appropriately reimbursed for taking care of Medicare and Medicaid patients.
RCM systems provide useful analytics that offer a detailed look at patient populations. This is a way to better understand the percentages of your patient population who have been diagnosed with specific chronic diseases. Aside from allowing you to better monitor the claims data, this will enable you to better assess any aberrations in your metrics.
Common RCM Pitfalls
Billing and Collections
Without an effective billing process, you run the risk of losing money. Since high-deductible insurance plans have become increasingly common, patients are paying more money out of pocket. If a patient is uninsured or underinsured and complications arise, there is no guaranteed payment method beyond setting up a payment plan.
Lack of price transparency on bills patients receive can cause confusion. Reducing confusion and patients’ perceptions that they are receiving unexpected charges makes patients much more likely to pay in full.
Providers risk losing business if they put too much pressure on their patients to pay for their care. This is why it’s crucial to collect the correct information at the initial point of service. Tracking down patients can become extremely difficult when there is a lack of data available or when incorrect data appears in a patient’s file.
An effective medical bill process is essential to ensure financial stability. Ensuring employees understand how to collect data and input it into the system correctly is an integral part of the workflow that can easily prevent future headaches.
Work With Up To Date Technology
Having an outdated IT system can cause a lot of harm. If employees struggle to use the programs and do not understand how to properly input data, it becomes easy to make mistakes that could otherwise be avoided. It keeps staff happy when the equipment functions quickly and does not require them to jump through hoops that feel unnecessary or overly complex.
Inadequately Trained Staff
Employees who lack proper training are more likely to make costly errors. Staffers need to know how the billing process works so that they do not lose track of claims. It’s surprisingly easy for claims that are 60 or 90 days unpaid or delinquent to be overlooked by a staff member who is not paying close attention to detail.
Monitoring the Claims Process
Medical billing is complex. There are multiple parties involved, and all of them are most interested in their own invoices being paid in full. Automated alerts are one way to keep employees attentive to individual claims. Trained staffers must know why claims may be denied and catch billing errors while correcting coding issues to keep the RCM process on track.
Reach Out to CodeMax For Your Medical Billing Needs
At CodeMax, we are committed to helping make the medical billing process as straightforward as possible. If you could use a hand developing or upgrading your systems for billing and Revenue Cycle Management, we are here to make your life easier. Reach out to us today at 866.471.3267 to speak with a trained representative to discuss how we can be of service to you.