Revenue Cycle Management and Why HealthCare facilities should find an RCM partner today! -Avontix

Did you know that Insurers reject nearly 26% of all claims and up to 40% of those claims are never resubmitted? This means every physician can lose up to 10% revenue. Introduction of Revenue Cycle Management Systems can increase payments and decrease the bad debt write-offs.

Let us see what RCM is and why it should be implemented:

Revenue cycle management, as the name suggests, is a financial process, that’s utilizes medical billing software, used by healthcare facilities to track patient care cycles starting from registration, appointment scheduling to the final payment after the consultation.

RCM integrates the financial and clinical aspects of healthcare industry by consolidating the administrative data, like a name of the patient, details of the insurance provider and other personal information, plus the details of the treatment received by the patient and his/her healthcare data.

The key feature of RCM is interacting and communicating with the insurance companies. The process begins right when a patient calls and schedules an appointment; the physician’s staff then immediately checks the patient’s insurance coverage before his/her visit. Once the insured patient receives the treatment for a given ailment that he visited for and pays the applicable sum, the coder classifies the nature of the treatment based on ICD-10 codes. The hospital facility then sends the treatment summary with ICD codes to the patient’s insurance company to check what portion of the treatment will be covered by insurance policy, so that the patient can be billed for the remainder sum (if any).

A Typical Revenue Cycle:

The revenue cycle includes administrative and clinical functions which contribute to capture, manage and collect patient treatment dues.

Here is what’s involved in the revenue cycle:

  • Charge capture: Translation of medical services into billable amounts.
  • Claim submission: Submission of claims of the billable charges to insurance companies.
  • Coding: Accurately coding diagnoses and treatment procedures.
  • Patient collections: Arriving and accurately determining the balances payable by the patient and collecting the same.
  • Pre-registration: Collecting complete information of insurance coverage, before a patient arrives for the relevant treatments.
  • Registration: Collecting the remaining patient information at the time of registration to initiate the medical record so as to meet all the administrative requirements.
  • Remittance processing: Applying or rejecting the due payments through the process of Remittance.
  • Third-party follow-up: Collecting the payments due from third-party insurance companies..

Problems with the Exiting Practice:

Staff has not been properly trained or educated:

One person’s incorrect job will affect the entire chain. Coding errors, incorrect data entry or a simple lack of understanding on how their work affects the revenue can result in some costly mistakes.

Lack of communication between staff:

Not everyone in the office understands their role in the revenue cycle. Therefore, any hampered communication between physicians and office managers will prove expensive. They must remain open and conduct regular meetings to review the financial reports.

Poor workflow:

Does it take long for your staff to follow up on claims? Do they take patient eligibility details before the patient arrives? Please be informed that without a channelized workflow, you may end up missing a few most important and crucial things.

Benefits of Revenue cycle Management:

 An effective RCM system can considerably lower the time lag between service and payment of receipt by
combining with other systems

— such as EHR (electronic health record) and medical billing systems

— as and when patients move through the treatment process. RCM can also save considerable time of the healthcare organization by employing automation in areas that were earlier handled manually by the employees including administrative functions such as informing the patients about upcoming appointments, reminding about payments dues and co-coordinating with insurance companies when a certain claim is rejected.

If you interested in optimizing your revenue cycle, consider finding a a Revenue Cycle Management company that will partner with you to get the most out of your revenue cycle.  

Don’t wait — every day is valuable! 

Seek out an RCM Partner today.

Revenue Cycle Management and Why HealthCare facilities should find an RCM partner today! -Avontix