Healthcare revenue cycle management is an essential part of the financial health of a healthcare facility. It includes scheduling patient appointments, collecting payment and insurance details, and finalizing patient balances.
Inefficient revenue cycle processes can hurt a healthcare facility’s bottom line. By streamlining payment processes and implementing effective RCM strategies, healthcare organizations can improve their cash collections, avoid aging accounts receivables and optimize operational efficiency.
Patient Registration
Patient registration is one of the most crucial steps in healthcare revenue cycle management. It involves capturing patient information, including demographic details, insurance coverage, and medical history. This information is crucial for generating a medical record and providing the hospital with all the relevant details about each patient.
Ideally, this step should be done before each scheduled visit to the practice. This helps streamline the entire process, reducing wait times and improving patient satisfaction.
Another key benefit of this process is that it reduces churn by ensuring new patients are given access to the right services at the correct time. This can improve overall patient experience and increase customer satisfaction and referral rates.
Capturing accurate demographic information can also save practices money by avoiding costly claim denials and payment delays. By establishing a standardized process, organizations can ensure that all critical patient information is captured correctly at the beginning of the revenue cycle.
Billing
Billing is the process of collecting payment for healthcare services, and it’s a key component of healthcare revenue cycle management. Medical billing involves coding treatments and services, verifying patient insurance information, and deducting copays and deductibles from the total cost of the procedure or service.
A healthcare practice’s billing department must ensure that patients are billed accurately and timely so that the organization receives reimbursement for its services. However, a lack of quality coding and poor workflows can lead to denied claims or payments stuck in accounts receivable.
Many healthcare practices use electronic medical billing software to expedite the coding and billing process to avoid these issues. This can help improve cash flow, staff performance, and patient satisfaction, reduce costs, and increase revenue. RCM software also helps identify leakages in revenue generation and plug them.
Collections
Collections in healthcare revenue cycle management is the process of collecting patient payments and submitting claims. This is done by administrative staff as well as medical billing professionals.
The first step in the process is to verify insurance coverage. This ensures that patients do not receive services they are not qualified for. It also helps to avoid denied or delayed claims from insurance companies, which can delay reimbursement and cause delays in the cash flow of your office.
Following up on denials and resubmitting the claim if necessary is also important. This can help avoid delays in reimbursement and improve the accuracy of your billing and coding.
Remittance
Remittance is transferring money back to a practice or hospital after insurance payments. It is an essential part of healthcare revenue cycle management because it allows the practice or hospital to receive payment for services as quickly as possible.
A well-established remittance process can help save time and money in the long run. It reduces the chances of human error and identifies claims that need additional follow-up.
Another important element in the remittance process is fee schedules, documents showing the amounts providers charge for their services. They should be reviewed regularly to align with adjusting rates, contracts, and allowable.
The remittance process also includes write-offs, both contractual and non-contractual. Contractual write-offs are normal and unpreventable (unless the practice or hospital renegotiates with insurance carriers). However, non-contractual write-offs can be prevented by implementing processes and procedures that will prevent them from happening in the future.
