In an ideal world, the art of providing healthcare would consist solely of one-on-one interactions between a clinician and a patient. The patient would pay for the services provided, the physician would utilize the payment to acquire items to maintain his practice, and the revenue cycle management outsourcing would start all over again. Of course, this is an unduly simplified depiction of our existing healthcare system, which hasn’t existed for hundreds of years.
On the contrary, we’ve established government programmes and insurance companies to allow clinicians to offer care to those who might not be able to afford it otherwise, as well as to ensure physicians are paid for their services. Meanwhile, technology advancements have enabled us to provide a higher level of care and more complex treatments than ever before; others have become a critical repository for patient data, including health records, treatment information, and more.
These and other examples have helped to shape healthcare into the vast yet sophisticated system that it is today. While many of these measures were design to offer patients and clinicians with security, essential supervision, and accessibility, they have also combined to add a number of additional steps to the process of receiving care. As a result, the United States’ healthcare system is becoming more complicated — and more expensive.
With global healthcare spending estimated to exceed $6.0 trillion by 2027, it’s no wonder that the expenses of obtaining healthcare and providing healthcare have climbed in lockstep. While medical billing businesses prices to consumers have increased by 4.6%, a significant concern remains: how do healthcare operations manage the delicate balance of handling more procedures, more providers, more regulations, and more money than ever before, all while keeping a check on internal expenditures? Revenue cycle management outsourcing is the solution.
What Is the Revenue Cycle Management Outsourcing Process?
Top RCM Companies follow each patient care case through each stage of the relationship. Revenue cycle management strives to centralize all financial data relating to each patient in one location, beginning with initial registration and appointment scheduling and continuing through the actual care and service provided and the billing cycle. As a result, RCM integrates both the clinical and commercial aspects of a practice by offering a platform for managing treatment and healthcare data alongside administrative information such as a patient’s name, billing information, insurance provider, and more.
The Healthcare Revenue Cycle Steps
There are numerous steps in the healthcare revenue cycle. This means there are numerous opportunities for mistakes to occur. Any faults in the revenue cycle might cause the provider’s reimbursement from insurance and patients to be delayed or halted entirely. Let’s take a look at the processes in the healthcare revenue cycle to get a better grasp of where errors can arise and how RCM can prevent them:
Pre-approval and eligibility verification
When a patient schedules an appointment, the healthcare provider gathers information in order to create a patient account. This includes gathering the patient’s insurance information and verifying their eligibility for coverage.
Even if a patient already has an account with the provider, revenue cycle management outsourcing highlights the need of correctly completing this stage. Incorrect information or ineligible insurance will result in a claim being deny later in the revenue cycle. This means that the provider’s reimbursement payment will be delay. It also involves more work for the clinician, who must then go over the patient’s information to remedy any inaccuracies.
Claims submission
Once a patient’s treatment has been properly cod, the claim sent to the insurance company for approval. RCM ensures this submission happens quickly by tracking and managing the claim from the start of the process.
Capturing and coding of charges
Charge capture is the process of converting patient treatments into billable charges by using globally accepted medical codes. These codes are use by insurers to calculate reimbursement amounts.
The insurance company may deny the patient’s claim if proper medical coding is not used. As a result, provider reimbursement is delay. It also costs the provider time and money to investigate and appeal declined claims. Effective revenue cycle management outsourcing ensures coding correctness, allowing denials to be avoid entirely.
Payment collections
Following the approval of the patient’s claim, the insurance company reimburses the physician depending on the patient’s eligibility. If there remains a balance after insurance reimbursement, the provider is responsible for contacting the patient to collect the balance.
By optimizing claims processing, revenue cycle management speeds up the patient payment process. Furthermore, because RCM places a greater emphasis on front-end processes such as insurance eligibility verification, patients will know what out-of-pocket charges they are responsible for paying from the start. This, once again, aids in avoiding any delays in collecting the final payment.
The Advantages of Revenue Cycle Management Outsourcing
Effective revenue cycle management ensures that these processes are completed thoroughly and precisely, allowing providers to prevent revenue delays or loss.
Although the primary purpose of RCM is to enhance provider revenue, it also provides additional benefits. These benefits benefit both providers and patients, making revenue cycle management even more valuable.
Error Detection and Resolution
Implementing RCM allows healthcare providers to more quickly identify where errors occur in the revenue cycle. This reduces the likelihood of claim denials because over 90% of claim denials are attributable to easily avoidable technical errors, such as missing information in the patient’s chart or incorrect coding. When these errors are avoid and claims are grant on the first attempt, providers receive their payments fast. They also save money by not having to investigate and appeal disallowed claims.
Claim denial prevention can result in an additional $5 million in revenue for the average hospital. This figure alone should be reason enough for healthcare practitioners to inquire about how an organization can enhance its revenue cycle management.
Reduced Administrative Burden
Preventing claim denials also reduces the administrative load. Administrative staff members have more time and energy for patient care when they do not have to spend time and energy investigating and appealing refused claims.
Furthermore, RCM’s particular attention to front-end activities improves interactions between administrative personnel and patients. Appointment scheduling, intake form completion, and payment processing are all optimize to provide a better experience for everyone.
Avoiding Healthcare Fraud
Another key advantage of RCM is its ability to prevent healthcare fraud and misuse. Every year, healthcare fraud costs the healthcare business billions of dollars. A fraud inquiry can cost a provider both income and reputation.