Healthcare providers have the responsibility of protecting the health and well-being of the general population. In order to achieve business excellence, they adopt best strategies to accomplish it to its full potential. Good business practises and financial health of the organization are important to maintain the smooth functioning of the core business competencies. Healthcare revenue cycle management thus gains prominence and helps organizations manage the core business developments whilst keeping the company`s finances robust.
Revenue cycle management services assist healthcare providers to effectively manage the administrative and clinical functions related to claims processing, payment and revenue generation. The RCM, when managed professionally, has the potential to streamline cash flow, helping hospitals and clinics keep their finances flowing. There are many emerging revenue cycle management companies that make the process smooth and cost-effective.
Revenue Cycle Management- An Overview
Revenue Cycle Management is the process of identifying, collecting and managing the healthcare organizations` revenue. An optimal RCM practise is important for global healthcare practices. Hospitals worldwide are looking at ways to inculcate a value-based reimbursement procedure while providing holistic patient care. Good revenue cycle management companies therefore strive to ensure optimal financial viability.
However, it was noticed that poor billing processes resulted in huge financial losses and put healthcare organizations at a huge risk in terms of delivering quality care. Therefore, hospitals are striving to augment and streamline the core operational procedures to maintain financial stability.
The Changing Trends in Revenue Cycle Management
Over a year ago, revenue cycle management was in a transition phase with increasing costs and debt write-offs across medical practises. In order to stay ahead of the development and business curve, healthcare organizations started exploring technology solutions that offered optimized data. The data was chosen based on the data-driven financial performance insights.
With the onset of the year 2020, things drastically changed in the world of healthcare. The ongoing pandemic, rising number of critically ill patients, huge investments in vaccine research, clinical trials and more have impacted the healthcare sector. It is quite clear that the categories of patients are changing too. Keeping pace with the changing times, global healthcare providers have chosen to outsource revenue cycle management to enhance cashflow and augment smooth healthcare management.
Since finance is a crucial part of healthcare management, the role of revenue cycle management services gains prominence. People worldwide are more aware of the changing trends. They are more cautious with their decisions and the awareness has had a huge impact on healthcare services. The silver lining is that payers have become aware of and are willing to invest in suitable preventive care.
Technological advancements, use of artificial intelligence and more have added dynamism to the revenue cycle management services. The challenges in the healthcare sector are rife with an upsurge in overhead expenses and the need to specialize staffing which will impact the medical practises` outcome in the coming years.
The Factors That Impact Revenue Cycle Management:
The revenue cycle begins when patients take an appointment and it culminates with the payment collection. There are many intermediary steps that must be efficient enough to ensure successful RCM.
Human Error: Errors in coding, medical billing and erroneous clinical data management often result in loss of revenue. Miscommunication and spelling errors can also be detrimental for effective revenue generation.
Regulations: The rules and regulations in the healthcare sector have been subject to change at regular intervals adding to the challenges in timely reimbursements.
Reimbursement models: There have been changes in the reimbursement models making it a cumbersome task to reimburse claims. This impacts the staff time and may often need suitable software upgradation to facilitate smooth medical reporting and revenue cycle management.
The Major Concerns in Revenue Cycle Management:
The healthcare industry has faced challenges that have resulted in huge losses and a rise in healthcare costs. According to the National Health insurer report, healthcare organizations have incurred substantial losses to the tune of 5- 12% of their revenues.
The losses were mainly due to errors in claims submissions and documentation procedures that include:
Lack of proper training: Healthcare providers must look into ways to train their staff or install systems that can effectively manage the workflow. A misspelt name or an erroneous code can have a huge impact on the claim’s submissions, often leading to denials. The hospitals should rectify the shortcomings to ensure seamless revenue cycle management.
Changing regulatory atmosphere: Hospitals and other healthcare organizations often have to bear the brunt of changing regulations and adhere to the government laid rules and regulations that change with time. Hospitals are still coming to terms with the ICD-10 compliance to ensure that billing and revenue cycle management are optimized.
The change in technology: The role of Artificial Intelligence cannot be ignored as it has a huge impact on almost every phase of the revenue cycle management. Hospitals and healthcare organizations often consider three main areas, namely- registration of the patient, medical billing and claims management. Every step of the way, hospitals worldwide are looking at ways to minimize costs, reduce claims denials and foster effective revenue cycle management.
The Role of Medical billing in Revenue Cycle Management
RCM is an umbrella term that covers areas like medical billing, medical coding, payment and co-payment collections and more. Medical billing is one of the integral aspects of revenue cycle management. Often, hospitals and healthcare providers work with limited available resources. It is a viable network that connects hospitals and healthcare clinics in the US with providers and payers.
Medical billing and its impact on the RCM can be best comprehended when the different roles and billing functions are understood. Medical billing starts from the time the patient registers. Medical Billing Services play a vital role in helping hospitals augment the revenue cycle management services. Most practises and hospitals strive to achieve excellence through RCM. In order to achieve this, they hire experiences medical billing service providers.
It is important to note that to provide seamless RCM, the role of each member from the front office to the coding team and billing experts at the back office are important. The impact of medical billing in RCM may be best understood by knowing how the process is carried out.
The role of front office: Revenue cycle management begins when a patient books the doctor`s appointment. The front office employees at the hospital schedule the appointments, collect patient insurance forms, verify the eligibility criteria and ensure the primary and secondary coverage of patient. They go the extra mile and make appointment reminders to ensure that patients are punctual and present on the scheduled date and time. They categorically ensure that the information submitted is accurate for smooth billing process. An efficient front office staff is responsible for good initiation of the effective revenue cycle management.
The clinical staff: The clinical staff ensure that patient loss is avoided by taking care of appointment reminders. Besides, they are trained to discuss finances with the patients, based on the respective insurance plans. They ensure the correct use of code and authentic documentation of the information and insurance plans submitted to help backend staff in quick and error-free billing to keep the RCM going.
Back-office staff in RCM: The back-office staff are an integral part of the RCM as they perform error-free billing and submissions for timely collections. They have been aptly known as the central part of billing and collections as they contribute significantly to the smooth revenue generation in practice.
The Evolving Trends in Medical Billing and Its Impact On RCM
The year 2020 has been a year of crisis across industries, more so, in the healthcare sector. The COVID 19 pandemic situation has impacted the global economy and the trillion-dollar healthcare industry is hit hard. With the onset of the pandemic, the healthcare trends are also making waves. The unprecedent times that lay ahead are going to bring more changes that will impact the revenue cycle management.
Technology: The arrival of the cloud-based revenue cycle software, and the strong presence of Artificial Intelligence in medical billing will impact the billing trends in 2020. Besides, the healthcare systems worldwide have shifted to a value-based care. This has forced medical billing companies to dispose localized and personalized services and choose innovation and innovative revenue models.
The changing role of Data: In the years ahead, information privacy, quality of data and more will be of primordial focus. Secure data exchange is the need of the hour and data security best practices should be put in place to ensure maximum security. Data quality will be enhanced with artificial intelligence in the years to come.
Minimized revenue leakage: Better regulatory compliance and reduced reimbursement and ever-increasing consumerism have led to lower revenue leakage. This will ensure that healthcare facilities are able to manage their costs better and smoothen the RCM.
The Major Attributes of RCM Outsourcing:
Years ago, the healthcare sector relied largely on physicians and billing services provided by hospitals and physicians. As healthcare technology progressed, the trillion-dollar industry focussed on patient needs and effective revenue generation.
Healthcare service providers are looking at options to outsource patient data management, medical reporting and medical coding, in a bid to streamline business. In the past, the designated roles and responsibilities of doctors and clinical staff have contributed to best healthcare. But when they also have to focus on patient data management, their focus and efficiency may get diverted. In order to ensure smooth and uninterrupted revenue cycle management, outsourcing it to a reliable provider is a practical option. RCM outsourcing helps healthcare industries manage their resources while strengthening their core business competencies.
The Benefits of Outsourcing Revenue Cycle Management are Explored as Below:
Optimum Patient Care: The everchanging healthcare industry has to keep up by providing optimal patient care. Earlier, most healthcare practises monitored RCM all day long but ended up being distracted in providing optimal healthcare. Highest standards of healthcare were not maintained, leading to a loss in revenue. Hospitals may achieve best patient care by choosing to outsource revenue cycle management to a reliable provider.
Reduces Staff and Costs: The RCM outsourcing partner will ensure accurate billing, repayments, registrations, and patient in and out processes to ensure that the healthcare facility can reduce staff and minimize costs. They may thus focus on enhanced patient care and professional networking.
Precise Reimbursements: The outsourcing RCM partner can focus on the revenue cycle and ensure timely medical claims and reimbursements. The main focus will be on collection and verification of the patient details to ensure that the medical information is accurate and thoroughly verified with no room for errors.
Uninterrupted Cash Flows: Outsourcing of medical billing and coding services is also important as the outsourcing partner has invested in the latest software and hardware solutions to handle precision-driven billing. Quick and diligent processes invariantly improve the cash flow. In turn, it also allows doctors to focus on medical treatment and technical seminars to hone their professional skills.
Minimized Billing Errors: The RCM partner has a dedicated team for billing and coding and they are trained to do their job with diligence. The investments in billing and coding software and hardware that augment the process is also in place. Thus error-free billing is the need of the hour to smoothen the RCM process.
Regulatory Compliance: It is important to keep the staff up-to-date with the regulatory changes and compliance issues. Your outsourcing RCM partner will go the extra mile to train the staff and introduce administrative workflows for assured compliance activities.
Enhanced cash flow and profitability: Healthcare practise that outsource RCM services the overall revenue and cash flow is automatically enhanced through best practises and diligent outsourcing services. Besides, your RCM partner also helps streamline operations to give healthcare professionals better control and transparency.
Increased revenue and reduced costs: In addition to reducing the overheads of staff salaries for internal teams, innovative software and other office expenses, RCM outsourcing helps businesses obtain payments by managing RCM operations thereby boosting profitability.
Why Choose MedbillingExperts to Augment Your RCM
MedbillingExperts specializes in providing quality revenue cycle management services to US-based hospital and clinics with the objective of ensuring every single penny owed is collected on time. We specialize in an array of services such as payment posting, insurance verification, adjustments, days sale analysis, AR receivables, denial management, AR receivables etc. Over the years we have assisted our clients streamline their processes with intensive claims prioritization, in-depth KPI assessments, dynamic process integrations, and enhanced access to data.
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