Revenue Cycle Management or RCM is a process that every healthcare system in the US uses to track revenue from their patients and streamline the process of revenue generation. It starts right from the first encounter of the patient with a healthcare provider, be it telephonically or a physical visit, and lasts until full payment has been made for the services rendered by the medical facility. RCM usually is a seven-step process as detailed below:
- Preregistration – It is a stage where the medical facility obtains information regarding a patient’s demographics, insurance, and eligibility through a clearinghouse in real-time, all while the patient is on call. It allows the practice to set a financial tone in the beginning by understanding the patient’s financial capability and preventing complications later on.
- Registration – At this stage, the provider collects important information pertaining to the patient, and ensures that it’s up-to-date every time the patient is treated. At this stage, all necessary financial forms are signed, while assigning the insurance benefits.
- Charge Capture – The process can either be automated or the providers’ staff can manually record all the charges for the patient, and bill the same to the insurance provider. It is important here that the right coding is done for every charge to ensure they correctly get to the insurance carrier.
- Claim Submission – The revenue cycle team now looks at the charges, CPT, and diagnosis codes, before submitting the claims. The claims are sent from your practice management systems to a pre-assigned clearinghouse, which then disburses them for the final approvals and payments to the different payers.
- Remittance Processing – Once the claims have gone out, they get remittances back from the insurance providers. At this stage, allowable is determined, where the insurer negotiates the contract with the provider to confirm how much they will pay for each service.
- Insurance Follow-Up – This is the stage where the practice makes a thorough analysis of all the completed payments and lists out what remains to be paid. A detailed accounts receivable report shows where there has been a lag in payments, and the frequency with which insurance follow-up must be conducted to ensure timely payments.
It’s best to answer questions like whether the billing teams are cross-trained, whether there are any noticeable changes, are claims being appealed, and whether there is personnel assigned to certain carriers. The answers will help you figure out the most likely cause of delays, and you can remedy the same.
- Patient Collections – This is the most difficult yet crucial aspect of a smooth RCM process. The front desk staff must be duly trained to collect the fees from patients while they are still in your office, to prevent collections backlogs. To ensure a better moving revenue cycle, you must increase the frequency of daily statement cycles sent to patients.
The RCM is a tedious yet important process for healthcare providers. Here are some RCM best practices you need for 2021:
#Being Attentive to Patient’s Requirements
Healthcare institutes with good RCM have recognized the need for a harmonious relationship with their patients and effective management of the same. They employ and train staff to work proactively ensuring patient satisfaction, building a positive relationship, and high patient loyalty.
Most patients find the medical billing process quite confusing and intimidating. In such instances, if the hospital staff openly interacts with them, while explaining the process in as much detail as they desire, it’ll help boost revenue collection from patients, with them paying their bills on time.
#Automate Prior Authorizations and Eligibility
To ensure smooth RCM, the staff should make it a point to verify patients’ insurance coverage during registration. Automating the process will significantly help in optimizing clinical processes, speed up the revenue cycle and save time otherwise spent on this task by the hospital staff.
#Invest in the Latest Technology
Automation is important to ensure all aspects of the RCM cycle function smoothly. Automated software systems help in streamlining prior authorizations, determining eligibility and billing, medical coding and alerting your staff to errors that need to be revised before submitting the insurance claims.
It will help save time and costs spent on settling unpaid claims and help in getting reimbursements much more quickly.
#Regularly Monitor Key Statistics
To ensure a smooth RCM process, you need to continuously monitor key statistics and identify errors in billing processes and claims filing.
It will help you become aware of the issues as and when they occur, and you can resolve them in a timely manner. You can also take the help of high-end technology and software to automate the process or hand over the job to professional revenue cycle management companies.
Tele healthcare is the future and has gained much prominence since the covid-19 pandemic struck our lives. It is now acting as an additional revenue stream for healthcare institutions, helping them reach out to the underserved population.
It is also helping increase schedule facility, by offering remote quality care, to maintain financial health. In such instances, it is a must for service providers to upgrade their systems, and improve the technology and reimbursement process of telehealth systems.
#Stay Abreast of Regulatory Standards
To improve RCM, medical institutes, and providers must always be aware of the latest regulatory guidelines. It includes adjustments to be made in services covered, technological requirements, any data on claims forms, and responsibilities regarding the patients.
As a provider, you must also understand the different types of services and the rules and coding associated with each of them.
Steps taken in the right direction will ensure an effective and highly efficient revenue cycle management system. A streamlined RCM process implies that your business’s financial health is great and the revenue is generated in a timely manner. It is always better to partner with RCM professionals, to help save your valuable resources, including time and energy, and utilize them to improve your core operations.
NetSet is a pioneer in providing RCM services to accelerate each of their client’s cash flow. Partner with NetSet Digital to get guided business intelligence, streamlined end-to-end processing, and thrive through change by leveraging the best RCM practices and generating higher and timely revenues from your patients.