Revenue Cycle Management (RCM) is a vital process followed in every business organization. To explain this, it is to ensure that incoming cash is sufficient to run further Business operations and planned expenditures. To ensure that difficulties such as billing and revenue management do not hinder the internal process and affect operations RCM is incorporated. It becomes more important when it comes to healthcare systems where payments are covered by Insurance and aren’t as instantaneous as at any retail store.
What is RCM specific to healthcare systems?
Many healthcare expenses are covered by Insurance; hence it is vital for healthcare systems to align themselves with Insurance companies of their patients, do prior verification checks and follow up on them. Here is how it’s done:
1. Claim prep: This is the first step to having an efficient RCM. This is where you collect the Patient’s information prior to setting up the first appointment. If it involves anaesthesia then the information is collected on the day of Surgery. This includes the patient’s eligibility and insurance coverage information as it needs to be verified in order to submit this claim to the insurance company. It is also essential to collect the correct demographic details of the patients to reduce claim rejections or denials.
2. Claim submission: In this step, the claim is submitted to the insurance company after coding the respective treatments provided to the patient. The initial verification of the patient’s benefits helps to determine whether this particular combination of treatments matches the eligibility criteria of the patient’s insurance company. Post scrubbing, the claim is submitted.
3. Claim Management: Insurance companies have their own protocols to check the validity of the claim. This is where under RCM, you have to follow up with the Insurance team and post any relevant payments.
4. Receivable Collection: This is where you collect the patient’s responsibility like copay, or any other payments which will not be covered by the payer. Along with this, the team needs to focus on the insurance payment recovery.
5. Analysis and Evaluation: This is the last step where your team collects and analyses data for the whole procedure, such as the expenses and payments from the payers and vendors. It is also the stage where you manage your Aging claims and write off non-collectible revenue, if necessary.
What are the benefits of a well-executed RCM?
A well-executed RCM has many benefits apart from just putting the money back into the business cycle. It helps to improve Revenue Performance. When money comes in easily and faster, the company can focus on improving internal procedures and finance expansions. It also increases the overall value of the organisation. Moreover, it simplifies the healthcare revenue cycle workflow. every practice is different, you need to identify the bleeders of your practice and implement the steps necessary to effectively manage your revenue cycle. Hope these tips help you with your Revenue cycle management altogether and benefit your firm just as much. Follow our blog to get more industry updates and understand more such concepts!