Revenue cycle management (RCM) is crucial for any organization’s financial performance in the healthcare sector. By documenting patient interactions, conducting claims processing, and managing revenue generation from insurance payers and patients, RCM is a procedure that aids healthcare providers in managing their financial operations.
Healthcare firms can maximize their profitability, improve efficiency, and achieve long-term sustainability by successfully implementing and optimizing RCM practices.
Patient registration, proper documentation, coding, billing, and collections are just a few of the many elements of healthcare operations that go into the complicated process known as revenue cycle management. Revenue cycle management’s role is to oversee the organization’s financial operations and manage the revenue earned by healthcare services.
Steps of Revenue Cycle Management (RCM)
Step 1: Patient Onboarding
Patient registration is the initial stage of the revenue cycle management (RCM) procedure. To construct a medical record, healthcare practitioners should ask patients for demographic and insurance information. Patients must be registered accurately to guarantee fast and accurate invoicing. The provider should gather the patient’s name, date of birth, social security number, insurance details, and contact information.
Step 2: Verify Patient Eligibility Automatically
The second step in revenue cycle management is patient eligibility, which is a task that can be easily transferred from your staff to an AI bot, making automation an easy solution for increasing productivity in your business. By checking patients’ eligibility for treatment in advance, you’ll lower the number of claim denials and remove a common source of frustration from your billing procedure.
The productivity of an office is affected by the addition of automation. Staff members can spend more time working on tasks that genuinely call for a human touch by avoiding monotonous and repetitive labor. Additionally, as individuals perceive the greater significance of their tasks, their morale often rises.
Step 3: Upfront Payment Process Verification
When a patient schedules an appointment with your practice, your staff should gather current information, including validating their insurance and preferred payment method. The patient should be able to enter this information throughout the self-scheduling procedure if they use your portal.
Because it is convenient and well-known to patients, giving them the option to pay online is an effective RCM strategy for practices to promote on-time payments. In general, your patients will respond better the easier and more accessible your payment method is for them.
Step 4: Charge Capture
The process of documenting and tracking every service offered to patients during their visit is known as charge capture in RCM. To prevent revenue loss due to underbilling, healthcare providers should ensure they appropriately capture all charges. In this stage, details about the services rendered, the date of the service, and the provider are recorded.
Step 5: Coding
Ensuring that healthcare professionals appropriately bill for services is crucial to the RCM process. Proper coding allows insurance firms to handle and pay claims promptly and effectively. Providers should use ICD-10 codes for diagnoses and CPT codes for treatments to identify each service they offer. Additionally, numerous code modifiers have a significant impact on prospective reimbursements.
Step 6: Claim Submission
Healthcare providers should submit claims to the relevant insurance carriers for payment after coding. Providers should make sure that all relevant information, such as the patient’s demographic and insurance details, provider information, and the services provided, is included in the claim. Claims should be presented on time to prevent a claim from being denied and payments from being delayed.
Step 7: Payment Posting
After processing insurance claims, healthcare providers must post patient accounts with the money they have been paid.
The process of submitting a payment entails comparing the amount paid to the amount billed and updating the patient’s account balance. Accurate payment posting is essential to protecting patients from being charged for services they have already paid for.
Step 8: Denial Management
Although denied claims are unavoidable, they can be reduced with planning and close attention to detail. For instance, hiring professionals to manage your revenue cycle can lead to an increased first-pass acceptance rate.
It’s also crucial to pursue claims that have been rejected. Many rejected claims get misplaced and never submitted again, costing medical offices money. Besides, your revenue cycle will be smooth if you have practice management software that automatically flags rejected claims for review and resubmission.
Step 9: Track Claims and Follow Up
Not all denied claims should be followed up on. Have a strategy in place for reaching out to clients who aren’t paying on time; it is worthwhile to write a script for your team to use.
Offer your patients a choice: would they like to create a payment schedule, make a complete payment, or find another solution? You’ll be able to maximize the money you make from these circumstances if you allow for this kind of flexibility for effective revenue cycle management.
Step 10: Reporting
Reporting is the last stage of the RCM process. To track the performance of the revenue cycle, spot trends, and make wise decisions based on regular reports provided by healthcare providers. In reports, include metrics such as claim volume, denial rates, and account receivable balances.
Bottom Line
Healthcare providers must adhere to these crucial procedures to optimize their revenue cycle management processes, reduce revenue loss, and boost profitability. Effective revenue cycle management requires accurate patient registration, insurance verification, charge capture, coding, claim submission, payment posting, denial management, accounts receivable follow-up, and reporting.
CareCloud offers tech-enabled RCM solutions to help medical practices streamline processes and ensure a healthier revenue cycle.
