Healthcare Revenue cycle management is the central unit of an organization that handles all the financial process and policies associated with different stages of patient from registration and admission till discharge using medical billing software. The management revolves around administrative side and finances of the organization.
RCM combines the business and clinical sides of healthcare by integrating administrative data that includes information like patient’s name, personal information, insurance provider etc .This practice is important in healthcare industry as it increases the revenue throughout the complete process of identifying certain problems and fixing them.
The process deals with the problems of waste, fraud, and abuse such as carrying out unnecessary tests and procedures. Claims processing, claim reimbursement, creation of invoice, and collection of payments come under the umbrella of healthcare revenue cycle management.
The need for Automation
The need for technology arises in healthcare industry for establishment of well-executed process and policy adherence. The traditional procedure involved long delays as claim submission and payment was a lengthy process. Now-a-days technology advancement allows smooth claim inputting and submission to meet the requirement for acceptance.
The cycle starts when a patient is registered and services are imparted and complete when all payments and relevant claims have been made. The process has certain complexities, thus, the need for automation is crucial. The following factors need to be taken care of:
- Scheduling Appointments – This is a process of scheduling systematic appointments that are patient-centric. The appointments are scheduled as per the time priority required by the patients.
- Account Establishment – The process of creating patient’s account in an organization. The account is updated consistently on the basis of services taken.
- Verifying Insurance Eligibility– the insurance eligibility and other related details are obtained from the patient and further verified using relative protocol.
- Identification of Medical History– This includes the thorough study of medical history of a patient which may or may not affect the patient’s health.
- Insurance Coverage– In order to keep a smooth claim process identifies patient’s insurance coverage and mandates.
- Medical Billing– For all the services rendered, this process is carried out to create accurate medical bills.
The technology in Healthcare Revenue Cycle Management can be helpful in many ways:
- Pre-registration – An advanced process that creates an account for the patient including personal details, medical history details, insurance coverage, and the related relevant information.
- Patient Scheduling– This is a process of scheduling systematic appointments from the initial stage keeping the time priority required by the patients.
- Automated Billing– Through basic data entries, invoices are created. Further, claims are identified, verification process is carried out, automated bill is generated, and claim submission is done. In nutshell, everything is done efficiently and seamlessly.
- Smooth Claim Process– The advancement in technology enables to identify human errors and loopholes, thus, claim return and rejection chances are drastically reduced.
- Optimized Back-end process – Automated software carries the ancillary processes of posting payment, processing statement, revenue collection, and claim acceptance or denial. The processes are carried out with minimal human interference.
- Quick Turnaround– The automated process helps in faster calculation of the total amount due. Also, bills are paid and claims are approved at a faster rate.
- Reduced Costs– There is fewer requirements of administrative staff as the work is done through the automated system which in turn saves the cost spent on the staff.
How Technology will help to Manage Healthcare Revenue Cycle Management
Investing in competent software that assists in managing health care revenue cycle management can do miracles towards profitability of a medical agency. The benefits of using software range from automatic coding and verification to claim denials, and the list is endless. The prerequisite towards choosing the right software is that it should be embedded with health-related IT solutions and big data analytics. This helps in efficient management of huge volume of information with effective alerts and dashboards. The RCM solutions on their own are very intelligent and efficient to predict the likelihood of a claim being rejected based on some information and data etc. These solutions also offer automatic alerts that direct the administrative staff on common issues that why certain codes or procedures are undergoing routine denials. Some features of RCM solutions include:
- Claim tracking through the entire lifecycle
- Collection of payments becomes automated
- Claim denial is addressed
- Revenue stream
- Adopting new payment models efficiently
- Improving payer communication
- Generating medical bills and coding and their monitoring
- Scheduling appointment for patients
- Better payer-provider interactions
- Bad debt avoidance
Automating Healthcare Revenue Cycle Management
The process of healthcare revenue cycle management is bit complex and possibility of human error is high and that is why automated RCM solutions are attracting organizations. The automated technology comes with various features that assist in better management of entire lifecycle of RCM healthcare such as data collection, front-end, back-end functions, authorization, and payment collection. Below are the steps to automate healthcare revenue cycle management-
- Merge Front-end and back-end Functions– Choose the solution in such a way that offers merging of front-end and back-end functions in which front-end should be patient-oriented and back-end should be payment-oriented. This is the best holistic healthcare plan that offers smooth process of payment. This also helps to monitor pending accounts.
- Tracking Revenue Performance– The software asks the system to make necessary changes before it’s too late.
- Optimizing Payment Process– The advanced technology updates the patient with payment reminder. There is no need for any staff to communicate this to the patient.
- Automated Authorization and Eligibility– The wasted costs can be reduced through verifying previous eligibility and authorization.
- Scheduling Appointment and Insurance Information– Better appointment is scheduled keeping in time priority of patient.
- Precise Medical Coding Solutions– ICD-10 Codes correct diagnosis is very crucial during patient registration. This electronic process reduces the chances of error.
- Electronic Claim-submission– This is the central solution that makes the entire process smoother. The solution should be chosen in a way to address all account receivables from registration to discharge at a single place.
- Adopting Standardized Software Tools– Software with multiple facilities and offers should be adopted that allows easy merging of entire process and make sure that no loopholes exist in the system.
- Enterprise Analytics Software– with the advanced software capabilities, the time can be saved and errors can be reduced at a higher rate. Efficient analysis with suggestions can be done at regular intervals.
Automation is the answer to the distress of the healthcare industry. Advanced RCM solutions upon being efficiently executed offers ultimate goal of maximized profits for every healthcare organization. Thus, technology helps to manage healthcare revenue cycle efficiently.
