What Is Healthcare Revenue Cycle Management?

While small & medium-sized healthcare practices, hospitals, and larger healthcare systems are known for providing healthcare to the patients and saving lives, it becomes the need of every healthcare organization to develop successful policies and processes for staying financially healthy. This is where healthcare revenue cycle management comes into play.

Healthcare revenue cycle management is the financial process healthcare facilities use to manage the clinical and administrative functions associated with claims processing, payment, and revenue generation. The process consists of identifying, managing, and collecting the revenues against services provided to the patients.

It is crucial to ensure that the healthcare facilities stay in operation to provide proper care to the patients. Through healthcare revenue cycle management and DME billing, facilities collect profits to keep up with expenses.

The basics of healthcare revenue cycle management

The process of healthcare revenue cycle management begins when a patient makes an appointment to seek the required medical services and ends when healthcare facilities have reimbursed all claims and patient payments successfully. However, the life of a patient’s account cycle is not as easy as it looks.

To start, the administrative staff is required to handle the scheduling, insurance eligibility verification, and patient account establishment.

Pre-registration is the key to ensure that the revenue cycle management processes is optimized. Employees create a patient account including all the details of medical histories and insurance coverages.

From the hospital’s perspective, the ability to successfully enter the correct insurance, verify accurate patient’s demographics, and collect the financial responsibility of the patients at the front-end reduces rework throughout the revenue cycle process. This, in turn, ultimately reduces the chances of potential denials.

After a patient visit is complete, the healthcare provider must work on the claim submission while taking care of the charge capture duties. The charge capture process documents the rendered services into billable fees.

The provider or coder identifies the ICD-10 code that corresponds with the treatment. This helps in determining the amount of the reimbursement the entity will receive from the patient’s health plan. Selecting the appropriate code for services rendered is the key to prevent coding related denials.

After a claim is created, the practice forwards the claim to the responsible payer with the purpose of receiving reimbursement. The process of revenue cycle management starts here for healthcare systems. Organizations are still required to oversee back-end office tasks associated with claims reimbursements including payment processing, posting, claim denials, collections.

Once an insurance company is done evaluating the claim, healthcare organizations typically receive reimbursement for their services. However, receiving reimbursements for the services provided to the patient depends on payer contracts and patient’s coverage. In some cases, claims can be denied for multiple reasons including inaccurate coding, missing medical records, wrong patient demographics, and many more.

Healthcare organizations must always take care of notifying about anything that the insurance does not cover and collect payments from the patient regarding the same.

Healthcare revenue cycle management aims at developing a process that helps organizations receive payment for the services covered under insurance, as quickly as possible. However, claims in revenue cycle management process usually takes a long period of time. Oftentimes, claims go back and forth between providers and payors until all the issues are resolved between both the parties. After adjudication, the payer will either approve or deny the claim. Depending on the outcome, the suitable measures are adopted.

The benefits of outsourcing your facility’s financial health to Eminence RCM

An effective revenue cycle management ensures that all the required steps are performed accurately to help providers avoid denials. Where the main aim of RCM is to increase providers revenues, it delivers many other benefits as well. These benefits not only serve the care providers but patients as well, offering greater value to the process for both the parties.
At Eminence RCM, we make sure that your healthcare facility receives all the benefits.

Some of the benefits of joining hand with Eminence RCM includes:

Increased chances of receiving reimbursements quickly

RCM helps healthcare providers to easily identify the errors occurring in the revenue cycle. The reduces the chances of claim denials since most of the denials happen due to easily preventable issues like missing information of the patient or inaccurate coding.
When such errors are avoided, the chances of healthcare providers to receive reimbursements multiplies. Added benefits – the healthcare providers aren’t required to spend extra money to investigate and appeal the denied claim.

Reduced administrative burden

The lesser the chances of claim denials, the reduced is the administrative burden. When administrative staff members are not required to spend time and energy in investigating and appealing the denied claims, they invest the freed-up time and energy on providing care to the patients.
In addition to this, RCM’s keen focus on front-end tasks eases the interactions between patients and administrative staff. Appointment scheduling, completion of intake form, and payment processing are streamlined to create a satisfactory experience for all.

Patient frauds

Patient’s dishonesty may also result in healthcare frauds. This can happen in 2 ways:
Engaging in medical identity theft - Medical identity theft is becoming a growing concern in the healthcare industry. It costs both the providers and its victims. Since revenue cycle management starts with verifying the information of the patient, any occurrence of identity theft is detected and addressed early in the process.
Providing inaccurate information – A patient may lie about their insurance coverage to receive the services they are otherwise not qualified for. Insurance verification is one of the first steps in the revenue cycle management. This ensures that any inaccurate information provided by the patients is quickly detected.

Following are the steps that we follow to help your healthcare receive all the benefits:
  • Scheduling
  • Eligibility Verification
  • Coding/Charge capture
  • Charge Submission/Billing
  • Payment Posting
Revenue Cycle Management – An important tool for healthcare providers and patients

RCM’s overall goal of multiplying the revenue of healthcare providers also works to benefit the patient. Since revenue cycle management increases provider revenue while reducing the number of hours spent on various administrative functions & additional services including credentialing, this means more time is invested in taking care of the patients. This also results in increased number of patient visits.

That’s why many healthcare providers choose to trust EminenceRCM. Our expertise in the field ensure that your healthcare facility is equipped with all the tools it needs to ensure a streamlined revenue cycle.

Schedule a Discussion:

Our Billing Experts are ready to work with you, Click on the below button and schedule a demo today.