A successful medical practice results from several different variables coming together and functioning seamlessly and accurately in a coherent manner. The revenue cycle is one of the most crucial among these medical practices and activities in the modern patient care realm. So, why do healthcare institutions or practitioners need revenue cycle management? Healthcare businesses may ensure they are paid for their services on time and correctly using revenue cycle management or RCM. Although this is undoubtedly advantageous to the doctor, the patient also benefits from it.
Let’s first discuss the definition of RCM before discussing why securing reimbursement makes it so crucial. in healthcare and patient or healthcare customer experience management.
How does Revenue Cycle Management work?
Healthcare providers can utilize revenue cycle management, as the name suggests, to manage their system’s clinical and administrative aspects, which are often complex, tedious, and need optimum accuracy.
The revenue cycle starts when a patient contacts the healthcare practitioner to make an appointment. The cycle ends when the last installment for the consultation and therapy is received.
The aim of revenue cycle management is to identify and resolve any sources of friction in the provider’s revenue cycle. Care providers can enhance patient service revenue and optimize claim reimbursements by effectively managing the revenue cycle with an industry-leading healthcare BPO service provider. Moreover, it can enable healthcare institutions or practitioners to concentrate more on treating patients. Most importantly, it will improve customer experience management in healthcare by making it frictionless and more satisfying.
Essential Steps in the Healthcare Revenue Cycle
The revenue cycle for healthcare has several phases. It implies that there are plenty of chances for mistakes to happen. Errors in the revenue cycle have the potential to completely stop or significantly delay the provider’s payment from patients and insurance.
Let’s examine the processes in the healthcare revenue cycle to better understand the potential sources of mistakes and how RCM might help prevent them.
Pre-approval and Verification of Eligibility
The healthcare provider gathers data to create a patient account when a patient schedules an appointment. It entails gathering the patient’s insurance details and confirming their eligibility. Outsourcing this task not only reduces the time and effort in-house employees have to put in to perform it but also increases the accuracy by decreasing the chances of errors.
Even when a patient already has an account with the provider, revenue cycle management strongly emphasizes precisely completing this patient admission and registration stage. A rejected claim will occur later in the revenue cycle due to inaccurate information or ineligible insurance resulting from any error in patient data or checking insurance eligibility.
This indicates a hold-up in the reimbursement payment to the provider. Additionally, it adds to the provider’s workload because they have to go through the patient’s records again to fix the mistakes that were made previously. It is an utter waste of time, effort, and resources.
Capturing and Coding Charges
The process of translating medical services into billable charges using internationally recognized medical codes is known as charge capture. Health insurance companies use these process codes to calculate their reimbursements.
It is absolutely essential that accurate codes are used while documenting medical services provided to the patient. The insurance provider might reject the patient’s claim if the medical codes are incorrect. The compensation to the providers is delayed as a result. Additionally, it costs the provider money and effort since rejected claims must be considered, challenged, and resubmitted for payment. However, a healthcare BPO can ensure correct medical codes are entered, and these solutions can ensure efficient revenue cycle management, preventing rejections entirely.
Submission of Claims
Following accurate coding of a patient’s medical services, the insurance company is contacted to approve the claim. RCM tracks and manages the claim from the beginning of the process to guarantee that it is submitted as soon as possible.
Receipt of Payments
Upon approval of the patient’s claim, the insurance provider reimburses the provider in accordance with the patient’s eligibility. The provider is responsible for contacting patients and collecting any outstanding payments following insurance reimbursement.
Revenue cycle management streamlines the processing of claims, which speeds up the billing process. Also, patients will immediately be aware of the upfront costs they incur due to RCM’s heightened emphasis on front-end duties like confirming insurance eligibility. Once more, this aids in preventing any delays in payment collection.
Review of Medical Services
Care providers are encouraged to assess clinical treatment data through thorough revenue cycle management. By examining this data, providers can determine where mistakes are made in the cycle and how to reduce costs. Consequently, this will enhance patient satisfaction and enable providers to make more money with enhanced patient experience in healthcare.
Final Words
The revenue cycle management (RCM) process with an experienced healthcare BPM or BPO service provider can ensure all these steps are performed efficiently for a healthcare service provider. Efficiently performed RCM ensures healthcare service providers are paid correctly and on time. However, it does not stop there. It also increases the revenue of these organizations. It reduces cycle time yet increases accuracy. So, the patient experience or healthcare customer experience management becomes seamless, and healthcare professionals can focus on patients and treating them rather than administrative issues and procedures.
