Revenue cycle management (RCM) is the management of finances, a crucial process that keeps an organization going on a daily basis. If facilities do not focus on their financials they would be scrambling no matter how excellent their patient care would be. In order to have an efficient revenue cycle, it is necessary to understand the various steps involved. Here are the various steps that are a part of the revenue cycle management and help a facility stay strong and healthy.
- Implement the process: The first step in the revenue cycle process is implementing the RCM software or outsourcing the process to RCM services providers who are adept at handling the process with exceptional efficiency. For healthcare practices that have limited staff expertise or large organizations that have branches, outsourcing is the best approach so that they can focus more on their core job of providing quality patient care rather than worrying about the financial matters.
- Patient access: This forms the basis for the entire RCM process where the effective functioning of the front office staff can minimize the claim denials and rework at a later stage. In this process, it is essential to check on the eligibility and benefits for patients.
- Pre-authorization: Prior authorization or pre-authorization is the next step in the revenue cycle process where the RCM services professionals have to obtain approval from the health insurer for the healthcare service, treatment plan, medications, or equipment to be used or performed that they are medically necessary for the patient. Pre-authorization is a pre-requisite for certain services with some exceptions in case of an emergency. However, one point to be noted is that pre-authorization doesn’t guarantee reimbursement of the cost.
- Claims submission: Payments for services performed will not be received until accurate claims are not submitted by the office. Practice management software comes handy for the process of automatic claims submission. Where the RCM process is outsourced, the RCM services professionals need to submit the claims and ensure that they are flawless. In the case of any denials, the cause of denial has to be resubmitted post rectifying the errors.
- Reimbursement for services: Once the claims are submitted, it is time when the insurance payers have to reimburse for the services provided. The payers would verify the procedures with their charges and check the insurance coverage limit. They would check if the bills are accurate and reimburse for their services.
- Collections from patients: When the reimbursements do not cover the services provided fully, then for the outstanding amount the RCM professionals have to send the bill and follow up with the patient to collect the amount from the patients. Medical billers who are an important part of the revenue cycle process have to rigorously follow-up and ensure that the patients pay the total amount.
Performing all the steps properly and in a timely manner will help streamline the revenue cycle effectively. Every healthcare facility whether small or big will need proper revenue cycle management which can be provided by the RCM services providers.