Medical Revenue Cycle Management Service

What Is Revenue Cycle Management (RCM)?

Revenue cycle management (RCM) is the process healthcare organizations use to manage financial operations related to billing and collecting revenue for medical services. RCM begins when a patient schedules an appointment and ends when the account balance is resolved through reconciliation of insurance payments, contractual adjustments, write offs, or patient payments.

RCM helps strengthen revenue by minimizing claim denials, reducing days in accounts receivable, and increasing collections. As a result, healthcare providers receive correct and timely payments and optimize financial performance. Effective RCM also can help healthcare organizations comply with regulatory requirements and improve patient satisfaction.

Steps for an Effective Revenue Cycle Include:

o    Appointment scheduling: Determining the need for services, along with collecting patient name, contact information, and insurance coverage details.

o    Registration: Completing patient intake, including insurance verification, front-desk collections, and collecting patient demographics

o    Charge capture for services: Assigning medical procedure and diagnosis codes for the encounter

o    Billing: Creating clean claims to receive reimbursement from insurers and provide bills for patient.

o    Denial management: Regularly reviewing denial reason codes to determine why a claim was denied and making corrections to prevent denials in the future.

o    Accounts receivable (A/R) follow-up: Identifying and following up on unpaid charges.

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Benefits of Healthcare RCM

RCM closes the gap between the patient accounts side and clinical side of healthcare. For instance, RCM links demographic data (patient’s name, insurance provider, and other personal information) with the treatment a patient receives.

A well-designed and proper RCM system streamlines the billing and collection cycles by accurately preregistering, making appointments for, and scheduling patients; collecting existing balances; processing payments; and questioning insurers when they deny claims.

The healthcare team (including providers, managers, and specialists in billing, coding, and preauthorization) communicates using accounting systems and electronic health records (EHRs). Using EHRs becomes easier with the help of RCM software or systems. This streamlining improves the turnaround time associated with offering a service and receiving payment for it, along with reducing administrative overhead costs.

RCM systems allow healthcare staff to enter all the information required for claims processing, which helps prevent the need to revise or resubmit claims. Reducing denied claims saves providers time and money.

RCM improves the patient care process, creating a better experience for patients. For example, through insurance eligibility verification, patients will know of any balance or financial expectations from the beginning.

Accurate billing and coding, as well as understanding the reason for denials, help improve the patient experience through appropriate charging, which leads to fewer denials. This accuracy leads to less stress for the patient and healthcare provider.

RCM systems enable patients to pay their bills online, and healthcare providers can use RCM systems for preserving and managing patients’ billing records.

RCM depends on documentation to support the medical necessity behind the charge. Patient safety is improved because the correct documentation leads to better overall quality of care for the patient. Many clinicians review the patient’s chart to ensure clear documentation, which provides a better overall picture of the patient problem.

RCM systems simplify reporting and analyzing data where necessary to verify that the revenue cycle is working and performing well within the organization.