Revenue cycle management (RCM) is the backbone of all the financial activities at healthcare organizations. It ensures that the hospital, clinic, or practice has the revenues needed to run its day-to-day operations. The process begins even before the patient walks in and might continue well after the patient has left. It is a highly complex procedure that is prone to errors which routinely cost precious revenues for providers. In light of this, using revenue cycle management solutions is not even an option for healthcare providers.
Choosing the right kind of revenue cycle management can be daunting for organizations of any size. The right type of solution will make RCM highly efficient and synergize with existing workflows. Let’s talk about some of the best practices to follow when choosing revenue cycle management systems.
How To Choose The Right Revenue Cycle Management Software
- Consult With The Key Stakeholders
The main stakeholders in the healthcare revenue process-flow include the RCM managers, billers, coders, the IT team, and everyone involved in the entire financial division. They are the ones who will be using the platform, and their insight will prove invaluable in deciding about an RCM solution. This group of stakeholders will best know what set of features will be suitable for the organization.
- Conduct a Requirements Analysis
Knowing what your organization needs is extremely important in deciding. While the group of key stakeholders would provide valuable insight on the desirable features, a professional consultant would be better able to analyze specific technical requirements and offer advice about the software available. Moreover, this type of analysis would reveal the cause of inefficiencies, pain points, and room for growth. For smaller organizations like practices and clinics, outsourcing the revenue cycle management process might also be feasible.
- Identify Goals
The reasons for choosing revenue cycle management solutions would be different for different types of organizations. It would depend on the size and type of services offered, which will also determine the objective for implementing RCM solutions. Things like lowering claim denials, reducing billing errors, scrubbing claims, and optimizing coding, among others, could be some of the objectives. Identifying these provides clarity on the selection process.
- Determine the Type of Software
You can either opt for a healthcare cloud based solution, or an on-premises one. A cloud based option will be not incur the initial expenses of acquiring new hardware or IT overhead. But the subscription fees might vary depending upon the set of features. The organization won’t need to worry about data security, software updates, or backend management.
An on-premises solution will require a significant initial investment for the hardware, implementation, and licensing. The organization would need to bear all the responsibility for maintenance, data security, compliance, expansion and upgrades. Depending on the size of the institution, this option could prove to be more expensive in the long-run.
- Find a Suitable Vendor
This is one of the most important considerations when it comes to choosing revenue cycle management systems. The company developing the software should have a good track record and positive reviews from its customers. Additionally, it should also provide technical support services in case of downtimes. It is also advisable to actually visit a few organizations using revenue cycle management platforms and get first-hand insights. Requesting a demonstration of the platform is a smart thing to do.
- Ensure Interoperability and Compliance
It is vital for healthcare revenue cycle management solutions to be interoperable with existing systems and third-party medical software. This will ensure that essential data can be exchanged across the organization for day-to-day operations. Problems with interoperability could severely impact the efficiency of revenue cycle management workflows. The existing data from RCM activities must also be compatible with the new software.
While interoperability is vital for everyday operations, regulatory compliance is essential for security and privacy of sensitive data. Healthcare revenue cycle management solutions must comply with regulations, and the vendor must follow best practices for healthcare software development.
The Impact Of Revenue Cycle Management Software
The use of a dedicated software solution for healthcare RCM streamlines all the associated workflows. It replaces manual processes with digitized ones and leverages automation to minimize human errors. The use of revenue cycle management solutions lower the chances of coding errors and in doing so, minimize the number of denied or rejected claims. Additionally, they optimize payment processing and boost the efficiency of the RCM operations as a whole.
In addition to streamlining all billing-related workflows, hospital revenue cycle management solutions with analytics help organizations gain insights. This feature would analyze the data generated from all the RCM activities and reveal patterns. These would highlight the pain points and empower the hospital or clinic to make informed decisions to address the problems. A data-driven approach boosts revenues and ultimately benefits all the stakeholders.
The use of revenue cycle management systems enables a relatively small staff to carry out billing and finance-related activities efficiently. Additionally, such platforms also pave the way for the adoption of newer innovations in artificial intelligence. As novel technologies like telehealth become mainstream and calls for value-based reimbursement models grow, the role of RCM software will only increase in all spheres of healthcare.