Besides offering the highest quality care, a well-implemented revenue cycle management is essential to the fiscal health of an organization. Hospitals and other healthcare providers should be fully aware of how RCM works, how to improve it and how to deal with challenges in an increasingly changing environment. A successful and healthy RCM process ensures timely revenue collection as well as financial viability in a company. Revenue cycle management is distinct to every organization, but regardless of the size of a healthcare facility or hospital, the main objective is always to maximize revenue and minimize expenses and debts.

With revenue cycle management, healthcare providers can ensure they are reimbursed quickly and accurately for services rendered. While this may appear beneficial to the service provider, it is also advantageous to the patient. The main objective of RCM is to ensure the provider is properly reimbursed, which leads to a greater benefit for the patient through access to care and services from the provider.

Here Is Why RCM Is Important to Healthcare Providers

• Reduced error and redundancy: RCM can help detect errors in advance and give time to rectify those mistakes quickly.
• Reduced time commitment: RCM helps streamline processes, from early patient registration to appointments and payment reminders.
• Reduced costs: With the minimal likelihood of errors and reduced time commitment, organizations can reduce the costs related to the management of their revenue.
• Fewer denials: By minimizing errors in payment claims, revenue cycle management can also lower the denial rate and speed up payments to organizations.

Healthcare providers usually buy and implement specific revenue cycle management systems in order to keep and manage their patient’s billing records. A good RCM system has the capacity to reduce the time between offering a service and getting paid. This can be achieved through Electronic Health Records (EHR) and billing systems as patients move from one stage of treatment to another.

Organizations can also use an RCM system to save time by automating most of the tasks that were initially performed by staff. Such duties may include alerting patients of their upcoming appointments, reminding patients and other payers of their existing balances and engaging insurance companies with specific questions, especially when claims are declined.

Additionally, healthcare providers can also use RCM systems to save money by obtaining insights as to why claims have been denied. More specifically, an RCM system is able to reduce the number of denied claims by triggering healthcare staff to input all necessary information needed for a claim to be processed. This prevents the need for them to later revise or resubmit claims. It also helps providers better understand why their claims have been declined and give them an opportunity to correct the mistakes. This also helps ensure that providers are well paid for handling Medicare patients.

A company can buy data analytics software and use it to monitor revenue goals. This will help the organization have a rough picture of where its revenue cycle needs improvement by classifying billing data and generating corresponding reports. Today, revenue cycle management systems also involve technologies like cognitive computing to ensure only accurate medical data codes are issued to the right patients.

Revenue cycle management has billing components, it goes beyond the submission of claims and the posting of payments. Most medical professionals use healthcare revenue cycle management solutions to track, assess and manage the status of patient claims.

Medical billing services deal with the submission of claims for all the services offered to patients. The insurance companies will then offer coverage based on these claims.

Revenue cycle management contains more information and processes as opposed to what is involved in billing services. RCM has everything to do with administering different financial transactions that emanate from medical encounters. These encounters are between patients and medical suppliers, health providers or hospitals.

The transactions include billing, coding, compliance, policies & procedures, data analytics, management duties, collections, payer contracting and healthcare provider enrollment. This shows how complex revenue cycle management is. RCM tasks begin immediately after a patient calls to book an appointment with your staff. That’s the time to conduct verification of benefits and eligibility with the insurance company, which can be done over the phone, online, through a provider portal, or through a verification module within the EHR/Practice Management System. After that, your staff can then explain to the patient his responsibilities in terms of paying bills.