Effective financial management is non-negotiable for healthcare organizations. Financial management in healthcare includes the management of money and chances in a way that benefits the organization. This is where healthcare revenue cycle management (RCM) comes into the picture.
The regulatory models and complex payer norms have become more challenging. As a result, many healthcare institutions outsource their billing processes.
RCM is the main brain of any healthcare organization in the essence of the workflow. Without proper cash flow management, everything would come to a standstill in a jiffy. These systems can automate a variety of operations that are carried out by human employees. This makes the process fast and more efficient.
The Basic RCM Process
Revenue Cycle Management (RCM) is an important financial process in healthcare. It enables practices to get reimbursed for providing care. The cycle comprises the steps that start with a patient making an appointment and ends when the hospital gets paid for providing treatment.
The first few steps in the cycle involve setting the patient's appointment, obtaining demographic data from the patient (such as insurance information, date of birth, and so forth), and confirming the conditions for claim submission and benefits.
The next step is crucial to optimizing revenue cycle management processes. Pre-registration involves the employees creating a patient account that describes their medical histories and insurance coverages in detail.
The tail end of the cycle comprises claim rejections, payment posting, patient billing, analysis of over and underpayments, and patient follow-up.
Automation Of Medical Billing Processes
Revenue Cycle Management tools automate essential components of the billing process like claim submission, remit posting, denial management, and reporting making the payment system efficient. Companies like Millin have been providing revenue cycle management tools to various health and social service companies.
Being able to automate certain revenue cycle operations can reduce the need for manual processes. This is crucial in a sector where there is a severe lack of qualified workers. This also increases efficiency by reducing manual intervention.
When an essential component can automate set practices, it relieves the workforce from the mundane medical billing process. This force can work for the main cause, which is caring for the patients.
According to MarketsandMarkets' most recent analysis, the revenue market for revenue cycle management services was projected to reach $40.9 billion in 2021. It is anticipated to reach $67.8 billion by 2026!
EHR And Revenue Cycle Management Integration
EHRs, or electronic health records, are essential for patient care as they streamline and arrange records and communication, guaranteeing consistent, high-quality care.
A successful practice requires seamless integration between your EHR and RCM. RCM overlaps with certain areas of the patient care domain. These processes can be streamlined to maximize productivity and income potential, allowing the staff more money to devote to patient care.
Important data from the EHR (such as patient details) immediately flows into your RCM platform upon the integration of the two systems. The RCM can then produce claims for payers.
Risks With Healthcare RCM
Consistency and organization are the two pillars of financial management at medical institutions. The majority of clinical therapies entail intricate processes that demand precision and excellence. For this reason, you require a solid revenue cycle management procedure.
The common issues associated with healthcare RCM are:
Inefficiently Trained Staff:
Sales cycle management is challenging even for seasoned handlers. The system can be confusing for ill-trained workers. Errors like faulty coding, missing data items, incorrect dates, and poor documentation can have severe effects.
Collecting payments from clients at or before the point of service is one of the main issues facing healthcare organizations. It might save time and effort if payments are collected before a patient leaves the clinic.
Coding and charge capture are also challenges faced by the RCM. Claims reimbursement can be an issue if a staff member makes a mistake in coding.
Healthcare revenue cycle management is still trying to keep pace with the dynamic healthcare ecosystem. Healthcare workers must know about their revenue cycle status to care for patients and be paid for their services.