What is Healthcare Revenue Cycle Management?

What is healthcare Revenue Cycle?

Revenue Cycle Management in Healthcare is a process where the services rendered to the patients are billed and payment is collected from the insurance or the patients. It is the complete cycle from which the patient pre-registers in the hospital to the last step of payment collection.

Why is Revenue Cycle Management Important?

Revenue Cycle Management is very important for any organization. In healthcare, it plays a pivotal role as it is very essential to maintain the healthy financial state of the organization. The cycle time of the entire process is very crucial. Revenue cycles in businesses should ensure that they get expected payments on a regular, predictable basis.

The overall purpose of RCM is to increase provider revenue, which benefits the patient first and foremost. Revenue cycle management helps providers earn more money while spending less time on administrative and clinical tasks. This means more money and time will be spent in providing better treatment and services to the patient and enhancing their experience.

Steps in Revenue Cycle Management Process

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  Pre-registration

  
  The first step is where the complete data on demographics and the medical history of every patient are collected.


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  Registration

  
  The details captured in the pre-registration process of double-checked and verified. Any deviation or error is corrected.


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  Charge Entry & Capture

  
  The information regarding all the medical services provided are captured and sent to the payers.


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  Utilization Review

  
  In this stage, health insurance providers assess the medical therapy requests of the healthcare provider.


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  Medical Coding

  
  One of the very important steps in the entire process. The entire medical procedures including the services, diagnosis, tests, etc. are coded as per the defined medical coding standards to submit to the insurance.


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  Claim Submission

  
  This is the actual medical billing and claim submission stage in which the claims along with all necessary supporting documents are submitted in the relevant forms.


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  Denial Management

  
  Any denials in the claims submitted are analysed, corrected, and addressed for payment of claims.


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  Insurance Follow-up

  
  The accounts receivable management team follows up with the insurance to process the denied claims and others to ensure maximum clearance of payments by the insurance payers.


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  Patient Billing and Collections

  
  After the payment is collected from the insurance, a statement is prepared on the balance of payment for the services rendered. This has to be borne by the patient and it is the responsibility of the collections team to ensure that it is closely followed up with the patients and is collected to ensure maximum revenue.

Challenges In Healthcare Revenue Cycle Management

As discussed in detail above, RCM, especially in the healthcare industry involves a lot of steps and multiple layers of processes. Hence, it is inevitable that the entire process would also confront numerous obstacles. Constant monitoring is required to ensure that there is no block in the process. If the problems are not resolved quickly, the providers will lose a lot of money. Some of the top challenges in the RCM process arises because of the below reasons.

• Coding and billing-related
• Credentialing
• Use of technology
• Compliance issues
• Healthcare data analytics
• Patient centricity

Technological Enablement In Healthcare Revenue Cycle

The advent of technologies like artificial intelligence and data analytics can aid providers in achieving more equitable reimbursement, streamlining procedures, and optimising the strategic use of human resources in the revenue cycle process. The success of revenue cycle management in the future is determined by the enhanced use of technology and its capabilities. Business Intelligence powered by technological advancements would sweep across the industry with huge transformations.

With new payment models coming in, there is an increase in the number of healthcare providers including hospitals and clinics who have already invested in healthcare revenue cycle management tools. RCM systems are projected to grow in popularity in the coming years.

With more automation in the space, the steps in the revenue cycle are getting simplified and the user interface is becoming easier.

Looking at the recent trends in the industry with respect to the technology boom, the investments for RCM software are in the rising trend. Keeping their long-term sustainability in mind, more than 80 percent of CFOs and their senior management team in the healthcare domain believe that technology must be integrated and optimised immediately.

It is the dawn of a revenue cycle revolution. However, the fruits of this digital transformation will not be completely borne until all stakeholders including providers, payers and vendors improve their use of technology to improve efficiency and transparency. Elevated patient experience is the key for all.

A healthy Revenue Cycle is a key for health care organizations to thrive in practice. Also, we need to understand and appreciate that healthcare revenue cycle management is consistently evolving. Hence investing in the methodologies and processes help grow the company strong financially and create a happy customer experience.

Use our BIS expert consultants for Healthcare Revenue Cycle Management Services to improve your revenue cycle, identify weak spots, calculate lost income or financial risk, and provide best-in-class solutions to improve the overall process efficiency and revenue of your organization.