What does Revenue Cycle Management mean?
The revenue cycle management process is usually associated with claim processing and revenue generation. The process of revenue cycle management starts right from when the patient books an appointment and ends when the revenue is collected from the patient. The process includes several steps like medical coding, charge entry, medical billing and much more.
Why has Revenue Cycle Management Healthcare become so important?
When it concerns healthcare, the quality of treatment offered to patients is essential. The healthcare provider needs an effective revenue cycle to maintain the necessities required for proper treatment.
In the healthcare industry, revenue cycle management involves loads of documentation, involving an enormous amount of patient data in the system. The use of technology in healthcare has the system running in minimalist errors. Healthcare professionals are very well aware of the benefits. Claims can be denied due to any negligence in the process and show financial restrictions as a result. The impact is visible on the revenue cycle.
Following are 5 major concerns in the field of Revenue Cycle Management in the Healthcare Sector:
1) Proper Authorization
The prior authorization process is a step of approval from the payers before the healthcare centre provides any service to the patient. It is required to plan out the course of evidence-based treatment of the patient that would match the requirement of the specific payer.
It is better to outsource to a Revenue cycle management company to optimize the claim rate, reduce denial and increase reimbursement. They use specific technological platforms to handle a particular aspect concerning the prior authorization process. Once the process gets executed properly, it helps meet payer-specific requirements resulting in the quick accomplishment of patient care.
2) Correct Charges
When it comes to medical billing, charge entry plays a crucial role. It involves charging the correct value according to medical bills and fees during the patient treatment, which will later determine the reimbursement of the physician in charge.
In the speciality healthcare sector, charge entry is a tedious job. It involves various specialists in a value-based program. The complexity increases due to multiple systems generating different kinds of information right from diagnosis to patient treatment.
Hence data interoperability is now in demand. It has been able to overcome the issue in the charge entry process. It is seen as a silver lining in the healthcare sector. The sector itself consists of maintaining several different records. Outsourcing charge entry can reduce the charge entry lag and attain an accuracy of about 98%.
3) Precise Medical Coding
Medical coding plays a vital role in Revenue Cycle Management. Coders have to stay up to date with guidance. Any error in this sensitive stage will create an adverse effect on revenue.
Therefore it is preferred to outsource medical coding to a reliable company to get relived the stressful process of keeping tabs on the frequently changing guidelines.
4) A/R Management
The accounts receivable (A/R) process is crucial for maintaining a good revenue cycle. It requires a dedicated team of professionals to set proper A/R benchmarks and meet them. It is also to avoid any backlogs and improve clarity on the revenue.
A payer validates if the service provider is capable of the skills required. For creditability, the certification and education of the physician or provider get verified to ensure the quality of treatment.
If the physician does not qualify, then the payers delay or refuse payment which will affect reimbursement. Hence the healthcare service providers must ensure the appropriate credentials for their skills.
Allowing external credentialing specialists will avoid any problems in checking the credibility and improving reimbursement.
By partnering with an efficient RCM service provider, you will improve your organization’s financial stability. Proper Revenue cycle management will help the organization as a whole.