A healthcare revenue cycle is used by hospitals, clinics, & healthcare facilities to manage the daily influx of clinical and administrative data. Revenue cycle management isn’t complicated, but it’s a laborious procedure that requires a significant quantity of knowledge to be exchanged across various hospital departments. This is a common reason why correct data is so crucial to effective business management.
For revenue cycle management to work correctly, several policy-making and clinical responsibilities must be carried out. So, from the time a patient signs up to the time an invoice is collected for payment, everything is covered.
To have a better understanding of how the healthcare system operates, consider the following features of the healthcare revenue cycle solutions:
1. Planned Programs
Streamlining the revenue cycle’s scheduling process is essential if healthcare providers continue providing high-quality care while also increasing profits. Because of cumbersome procedures and long hold times that decrease patient satisfaction, physician referrals are negatively impacted.
2. Pre-Registration of Patients
The initial step is critical even before a patient is enrolled in the system. Name, medical history, payer information, and payment method are just a few pieces of information we gather about each patient. These details are collected in advance of the patient’s first visit to the hospital.
3. Registration of Patients
All patient information acquired during pre-registration is supported during the registration procedure. If an error is found in a patient’s completed form, it is raised to the patient’s attention before it becomes a more severe problem. Hospitals may face extended delays in receiving payments from payers if they have errors in a patient form.
4. Charge Entry and Capture
Revenue integrity is the appropriate term. During the charge entry step of medical billing, healthcare providers record the details of their services and subsequently send the costs to the insurance companies. Revenue cycle management requires this technique since it ensures that their payers reimburse hospitals in full.
5. Medical Coding
Another step is the practice of describing procedures and diagnosis. A medical coding system is used at hospitals to translate a detailed description of services, processes, specific needs, and items into alphabetic or numeric codes.
Although these codes may be of no use to the individual, they are used by hospitals to develop a process map. To generate insurance bills & claims for healthcare providers and patients, medical billers use these codes.
6. Benefits and Eligibility Verification
As part of revenue cycle management, benefits & eligibility verification is a critical stage that can lead to a more significant percentage of clean claims.
We can avoid payment delays, invoicing problems, and payment failures by ensuring that the eligibility verification procedure is as simple as possible. The insurance plan’s coverage and benefits must be checked regularly.
7. Submitting a Claim
One of the key elements in the medical billing process is the submission of an insurance claim. The hospital will file the claims to the insurance companies during the claim entry process for the payment to be delivered under the contract’s conditions.
There will be difficulties in the payment processing and reimbursement to healthcare providers if claims are submitted with errors or other issues.
8. Denial Management
Payments are now either accepted or rejected in this crucial step after receiving claims. To determine if a payment has been approved or if a mismatch creates a delay, hospital accounts receivable administration examines the amount received from the insurance provider or payer.
It’s possible that if a mistake is made, your claim will be sent to the clearinghouse, where it will be examined and cleared before being returned to you with the correct payment amount you requested.
9. Follow-ups on Insurance Claims
By the American Medical Association’s estimations, only 80% accuracy is maintained in the healthcare industry when it comes to processing & paying claims. Insurance follow-ups are critical for the timely receipt of claims.
Denials, underpayments, and non-payments are all possibilities throughout this stage. If the hospital is not pleased with the reimbursements, they can alter the rates whenever the next set of plaintiff talks occurs.
10. Billing and Collections for Patients
Patient payments are calculated, and a statement is generated at the end of the healthcare revenue cycle management process. Healthcare management should keep a close eye on all of the past-due accounts.
Patients’ payment statuses are monitored. Patient demographics are becoming increasingly important as they are directly linked to a hospital’s profitability.
11. Cash Postings
By allowing us to see the payments and have a clear picture of the financial operations, cash posting makes it straightforward to spot problems and fix them immediately. A well-executed cash posting ensures that the revenue cycle management is being tapped into, which could lead to increased revenue.
Following the patient’s insurance plan & financial ability, cash posting might be manual or automatic. Manual posting is time-consuming and error-prone, which raises the chance of a mistake. When it comes to medical billing, Auto Posting is a digital solution that speeds up the process and ensures an uninterrupted flow of money.
12. Medical Reporting
Staying on track is essential to avoid costly mistakes, necessitating the practice’s use of quality reporting software. When your medical billing software includes quality reporting capabilities, it’s much easier to spot the usual errors that consume your money and improve your revenue cycle management.
Benefits of Revenue Cycle Management
1. Increase in Claims Paid After First Submission
To ensure that claims are paid on the first try, effective revenue cycle management places a high value on accuracy at the front end of the process. These front-end activities include verifying insurance, collecting accurate patient records, and coding correctly.
5% to 10% of claims are rejected after the first filing. Almost all of these denials are caused by human mistakes and technical difficulties. Code and insurance verification mistakes, or information missing from the patient’s chart, are some examples. It is possible to avoid denials of claims in 90% of cases.
2. Intensification of the Quality-Care Emphasis
You no longer have to spend money repairing mistakes or appealing claims when your practice utilizes revenue cycle management. As a result, medical practitioners can devote more resources to improving the standard of care they give.
Revenue cycle management can be used to help providers migrate from traditional fee-for-service reimbursement practices.
3. Minimization of Overhead Costs
Many administrative tasks must be completed when a patient requests an appointment, including verifying insurance and scheduling appointments. Front-end chores are streamlined with a revenue cycle management system so administrative employees can perform more effectively.
To top it all off, RCM makes sure that these administrative responsibilities are carried out correctly to avoid such claims being denied in the future. Administrators don’t have to spend time researching and appealing denials when claims aren’t rejected.
4. Improvement in Practice Collections and Profits
Healthcare facilities face a wide range of costs. Additionally, they must compensate their employees for their work for the patients they serve. The healthcare facility’s payments are delayed when claims are refused or patients seem unable to pay for services upfront, complicating the practice’s financial management.
The RCM helps practices identify trends of claim denial to prevent this from happening in the future. Techniques can minimize claim denials in the future and secure prompt reimbursement by identifying these patterns.
5. Enhanced Patient Experience
Efficient revenue cycle management improves the overall patient experience by emphasizing patient outcomes. Patients should expect better care tailored to their specific needs, decreasing their risk of re-admission.
A more pleasant interaction for both patients & administrative personnel can be achieved through RCM’s scheduling, finishing out intake forms, and billing features. In addition, patients will better understand their insurance coverage because of RCM’s emphasis on total insurance verification upfront. As a result, they won’t be surprised by unexpected costs down the road.