A complete walkthrough of the Healthcare Revenue Cycle Management Steps
Hospitals and medical practices have to make life-saving decisions for their patients. For this, they must be financially strong and keep the revenue flowing. This is where healthcare revenue cycle management comes to save the day!
Imagine, as a medical practitioner, you have to spend 70% of your time sorting the financials and integrities of the medical billing systems. What does that leave you with? A couple of hours to look after the patient’s health and wellness. It robs you of the chance to do your actual job, and the patient’s care might be compromised. With OmniMD, you can improve patient satisfaction without compromising your revenue! We are equipped with an EHR developed for physicians like you!
Revenue cycle management, or the RCM process, is a financial process responsible for a seamless experience from the registration to the final payment. RCM enables you to use online medical billing Softwares for better efficiency. According to InstaMed, 91% of consumers prefer electronic payment methods for medical bills.
With a dedicated team for RCM, patients can focus on getting better without worrying about the financial process. This blog will guide you through the nine crucial steps of revenue cycle management and how to optimize your medical billing software for a better experience.
Step 1: Design and Structure of RCM
It’s necessary to have a proper design and structure for an efficient revenue cycle management process. Some standard procedures and protocols have to be designed at the start to avoid any headaches in the long run.
Depending on the size of your hospital and the availability of staff, you can choose to allocate the RCM process to your staff members or dedicate a separate team focused solely on the smooth working of RCM.
According to a recent analysis, about 50% of healthcare leaders are adopting revenue cycle management software for medical billing to manage the revenue flow, while others opt to outsource to revenue cycle management vendors. If you have chosen to adopt healthcare billing software, ensure that you have proper training programs scheduled for your staff and they’re comfortable using it. However, a professional team will also need help from your staff for patient details, the verification process, details about the medical services, etc.
Assign your in-house team to work collaboratively with the experts to ensure a proper structure for the hospital revenue cycle management solution.
OmniMD has proudly served providers for 20 years, giving you a thorough walkthrough with analytical dashboards and robust reporting for a quick and convenient way to analyze large volumes of data. With about a year-on-year growth of the healthcare revenue management cycle ranging from 11% to 12% in the next 5 years, OmniMD will ensure you have the best to offer your patients.
Step 2: Patient Eligibility and Verification
Insurance companies do not cover certain medical services. To avoid any errors in the future, you have to verify the details on the patient’s account to understand the medical services their insurance companies cover for the patient. Verification is the most significant phase of RCM.
Without proper verification, there might be further discrepancies in claims, an increase in denied claims, etc. You can opt for medical insurance eligibility verification software to avoid trouble and maintain a transparent relationship with the patient. According to the data published by Change Healthcare LLC in 2022, 65.0% of U.S. hospitals and other healthcare facilities are using AI in their revenue management.
Make sure you check the expiry date of the insurance coverage, whether the patient signs necessary documents before they undergo procedures, and whether guarantors are mentioned in the policy with the help of insurance eligibility verification software. All the information has to be 100% accurate to avoid any risk of financial repercussions.
Step 3: Co-Payment
At the time of the medical service, the patient must pay from pocket any expenditure the insurance companies don’t cover. As many healthcare systems fail to collect payments during this period, you have to get this out of the way before any medical service for the patient starts. 74% of millennials (but just 27% of Baby Boomers) would switch healthcare providers for a better experience with payments!
If you need help determining whether you’re accounting for all the charges, hire an expert that can guide you through the process from start to finish. They can help unveil any missing charges and identify miscoded medical expenses in the claims.
Step 4: Coding
Coding is said to be the most critical step in RCM. The coders must be up-to-date with the latest changes in the coding guidelines from the federal authorities. Keep a close eye on CMS’s 2022 Medicare and Medicaid updates so you don’t miss out on any revenue.
Remember, most claims are denied due to the submission of outdated codes or misleading charges, so it’s crucial to pay extra attention and be thorough with them.
Step 5: Claim Submission
Once everything is in place, it’s time to fill out the claim form and submit it to the insurance companies. The RCM team is responsible for looking after the charges, the CPT code, and the diagnosis code to avoid any inconsistencies.
If your revenue cycle management team is diligent and sends clean claims to the insurance companies, you’ll get paid faster without any worries. Doing so can increase your clean claims up to 99%!
At the time of claim submission, take a thorough look at the transmission report that shows claims sent, claims coming back, and the claims dropped by the insurance companies. You must take a look at the rejection report as, well, which identifies any incorrect codes that need to be rectified.
Step 6: Claim Reimbursement
When an insurance company receives a claim, they cross-check their database for the patient’s policy and assign a reimbursement they deem fit. Any inconsistencies will lead to a decrease in the reimbursement amount.
The insurance company will send the Explanation of Benefits to convey the reasons for the denial. For this, you need to have a proper denial management workflow to ensure that you re-submit the rectified claims on time.
Do a complete examination of all the documents you might have missed on the last turn before re-submitting your claims. It’s best to hire an expert who can walk your staff through this process so the next time, you have fewer denied claims to deal with.
Step 7: Review for any payment variances
You will often get paid a different amount than the claims you submit to the insurance companies. This could be because of a lack of medical assistance or incorrect coding of the medical services.
Check in with your insurance companies and re-submit any rectified claims. However, with OmniMD, you are in excellent hands and can avoid adverse events or inefficiencies with the claims at any given time.
Remember, keep the patient in the loop so that there’s transparency in any financial transaction between the healthcare systems, patients, and insurance companies.
Step 8: Patient Collections
The most challenging step of an RCM process is collecting the remaining due amount from the patients. It’s tedious, uncomfortable, and sometimes frustrating. You have to give a proper explanation regarding their insurance coverage, and explain the discrepancies and reasons for denied claims while remaining calm and supportive of the patient’s condition.
It’s best to have a dedicated team working solely on patient collections with professional knowledge and experience in dealing with matters like these. 77% of providers say it takes more than a month to collect payments.
Ensure you have a standard policy for collecting any deductibles and copayments. Take time to clean up your revenue cycle management process. It will surely help you in the long run.
Step 9: Evaluation of the Financial Process
It’s crucial to analyse the finances from your revenue cycle management process to make wise decisions in the future. Ask the experts to walk you through the reports that highlight areas of pain points.
Evaluate where you’re doing good and strategize ways to optimize those areas further. When you take time to understand your mistakes, you’ll be able to rectify them in the future.
Let’s wrap It Up
A seamless system in place for revenue cycle management is necessary to ensure the success of any medical services without having to worry about finances. This way, the medical professional can give complete attention to the patient and their condition. Also, the patient can get well and heal without worrying about claims and financial expenditures.
Healthcare can save $20 billion or 48% of annual spending by fully adopting electronic transactions. With a service that integrates EHR, Practice Management, and Revenue Cycle Management Software, OmniMD will help you reclaim Patient – Centred Care with Simple, Yet Smart Medical Practice Technology. This means it’s trusted, verified, and integral to any healthcare revenue cycle management process. Our team is dedicated to serving you so that you can deliver the best quality care to your patients.
We hope these nine steps gave you a fair idea of the functioning of the healthcare revenue cycle management. With OmniMD, you can pick and choose options suitable for you. Click here to learn more!
How to Overcome Critical Challenges in Revenue Cycle Management in Healthcare
Today’s Challenges for Revenue Cycle Management in Healthcare Systems
Revenue cycle management is at the core of any health care service provider’s sustained existence and growth. The revenue cycle management process keeps track of patients and the revenue side of their treatment. Healthcare providers may make use of standalone revenue cycle management software or incorporate it into their medical appointment software or plug it into the EHR system. Regardless, it plays a crucial role and covers various steps.
- Steps in the revenue management process
- The hospital revenue cycle management process covers:
- Pre-registration of a patient
- Charge capture
- Claim submission
- Remittance processing
- Insurance follow up
- Patient collection
There is more by way of gathering data, analyzing it and deriving information that helps to identify weak spots and bottlenecks. The RCM system is complex and needs a thorough grasp of how it works for operators to derive the optimum benefit and overcome inherent challenges in the revenue cycle management. <According to Advisory Board, hospitals can lose about $22 million without having an accurate and efficient RCM in place.
This is a key but often neglected area. Personnel who use the RCM software often have to learn it on their own and barely get past the essentials. Knowledge of medical coding as applicable to that region is crucial at the preregistration stage and in subsequent billing stages. This involves a learning curve for which time is required. Due to this some service providers may consider outsourcing to a revenue cycle management company. Coding a medical claim can take hours and needs knowledge that in-house personnel may lack and, therefore it may seem appropriate to hand over revenue cycle management process to expert revenue cycle management services. It also entails additional expenditure so, for the long term, it is best to introduce a degree of automation at the pre-registration stage and put in efforts to get personnel to undergo systematic training, possibly by revenue cycle management consultants. If there is no precise coding then the billing will not be accurate and it results in a loss as well as delays in reimbursement. With training your personnel can overcome bottlenecks of coding, set up the hospital’s chargemaster and capture charges in addition to being better placed to inform patients about all that is involved right before they register.
Administrators and doctors in hospitals may not be familiar with how technologies work. Technology may be implemented in a piecemeal fashion with medical appointment software, EHR and revenue cycle management software working in parallel and in isolation. There is no connect between the data in each path and that poses challenges of streamlining operations and keeping tabs. It also becomes cumbersome for doctors or those in charge of RCM to refer to each and concatenate results leading to errors of commission and omission obviously to the financial detriment of the healthcare service. The smart thing to do is to engage expert revenue cycle management vendors or get revenue cycle management solution providers to integrate all disparate streams to be usable through a single interface. If usability improves it aids efficiency and personnel will make optimal use to enhance operations across the board from start to finish of the cycle.
The gaps addressed
Coding is just one part that could pose an immense challenge in the revenue cycle management process. There are others that affect smooth cash flow.
- It is vital for healthcare service providers to get their doctors accredited with insurance companies to avoid situations in which claims can be withheld on that ground. Overlooking this step can be a problem but it is easily taken care of with due attention right from the start when a doctor is going to be assigned to treat patients.
- The preregistration is a crucial step in which several key information can be missed such as insurance information and eligibility as well as financial expectations of the patient and payment modes as well. One needs to meticulously gather data at this stage.
- The registration step of the revenue cycle management process is another step that can face challenges due to inaccurate information and non-collection of advance payments and assigning insurance benefits as well as determining eligibility and amount.
- Missing charges is another challenge. Charge capture may be done through manual input of data or automated. Regardless, some charges such as ancillary services may be missed and if recovery is attempted at a later date then a refusal is likely. Revenue cycle management consultants could possibly help address this gap through measures like claims scrubbing technology to ensure coding is done right.
- Claims submitted to the insurance payer may not be in full conformity and this is also dependent on charge capture. Errors here may lead to refusal or delays. The solution is to vet each thoroughly and then track claims in real time to ensure only clean claims go through.
Accounts receivables, payments
It is often assumed that claims will be paid in full but that may not be the case. Insurance may pay less than expected and then it is for the healthcare provider to pursue the patient to pay the difference. Not paying attention to this could lead a mounting deficit. This deficiency can be overcome through the use of the right RCM system and by making the personnel aware about keeping track or, better, still, automating the system to send out a bill/reminder to patients fro such payments.
One must know how to analyze data derived from the revenue cycle management process, an area in which medical personnel may not be interested or capable of handling. It is essential that healthcare service providers know about key performance indicators and to keep watch over receivables as well as expenses and generate reports. Engaging revenue cycle management
consultants could bring your personnel up to speed in these areas. The RCM system generates and keeps on generating data that can be analyzed to derive useful information about revenue generation, reduce delays and address issues that affect processing. This is a challenge but training and familiarity through regular use of the revenue cycle management software by assigned personnel will deliver positive outcomes.
These are just a few challenges, mostly on the operational side but there will be others too such as software and hardware glitches from time to time. Retaining revenue cycle management consultants is one way to minimize and overcome challenges and ensure you get the most out of your investment in RCM software. Get in touch with OmniMD to resolve all such challenges and be prepared for future ones.
Boosting Revenue Cycle Management through Tech Optimization Techniques
Importance of Tech Optimization in Improving Revenue Cycle Management
There are street cars optimized across various performance characteristics but not excelling in any one. Then there are racing cars with fine-tuned engines, suspension and handling to excel in performance. This analogy can be carried forward to health care services IT solutions and their key performance metrics such as patient services and revenue generation. Given that technology forms the underpinnings of most operations of hospitals, their performance depends to a large extent on optimization and use of various such technologies like revenue cycle management software, EHR systems and medical appointment software, to name a few. Each can work in isolation and give results but optimization can result in resonance that will amplify outcomes. Take a look at the avenues of tech optimization to boost revenue cycle management.
Identifying the pivot
The revenue cycle management process comprises of several steps and the revenue cycle management software must work alongside other software if it is not installed as an integrated revenue cycle management solution covering EHR and medical appointment software as well as financial accounting packages. In order to optimize revenue cycle management you would first need to identify and focus on a pivot around which the other tech can be optimized. It is for hospital management and for doctors to decide on a core pivot, possibly in consultation with revenue cycle management consultants and revenue cycle management vendors as to which aspect should form the pivot. The RCM system makes for a good starting point since it incorporates vital processes from start to finish. However, there may still be other issues like interoperability.
Most healthcare services do not start with a bang; they grow and, along the way, incorporate solutions such as patient medical records and EHR, financial package, hospital information systems and EDI systems. One must also consider porting to clearing houses for insurance claims being part of the overall hospital revenue cycle process. These are implemented over time possibly through different vendors and work in isolation. Different operators may handle different software and solutions and the lack of connect between all these could translate to operational inefficiencies and that, in turn, affects revenue flows. Even the revenue cycle management software cannot deliver the best when working as a standalone unit. It pays to integrate all these standalone solutions and get them to be interoperable, possibly with the help of revenue cycle management vendors and revenue cycle management consultants working in tandem. Should these diverse systems be patched together or should you scrap them all and go in for an entirely new suite of comprehensive custom hospital revenue cycle management solution that works in the cloud?
A single dashboard revenue cycle management solution that ties in other packages like appointments and financials as well as tracking remote workers and giving them access as well as giving access to patients certainly results in reduced errors, faster processing and efficiency. Possibly revenue cycle management vendors could set up robotic automation, scripts and web apps to reduce task switching and improve productivity that will in turn boost revenues.
The end goal is to make processes convenient for doctors, administrators and patients and to offer accuracy as well as seamless automated integration. Optimization, you will find, is an incremental and iterative process across the various modules. RCM experts can help to continue with this iterative and agile fine tuning process.
Data analytics, speed and transparency
The sub-components of revenue cycle management processes are interdependent and contribute to the iterative fine tuning process to boost revenue cycle management. Once systems are integrated you get access to cohesive data that lends itself to better analytics. Analytics can show up insights for improvements that can, when implemented, speed up various processes, especially that of debt collection and also contribute to transparency. Speeding up iterations based on feedbacks leads to further improvements and so on in the revenue cycle management process.
The patient side
Patients are the primary source of revenue. Optimizing the patient side of operations improves the user experience. Tech optimization can be implemented across areas such as incorporating convenient payment gateways, permitting patients to choose pricing and payment plans, access to support from other sources and knowing exactly how much they will pay for services. Health care services that incorporate these optimizations in revenue cycle management process benefit by loyalty, referrals, faster and timely payments and excellent relationships.
Post the pandemic and given the rise of telehealth and cloud based healthcare services, remote workers are just as important as in-house employees are to the hospital revenue management processes. In fact, according to a survey conducted by McKinsey & Company, telehealth utilization has increased by 38 times compared to pre-pandemic situation. Hence, it is essential to keeping a track of them and facilitate their work to boosts revenue cycles.
Data based decisions
Tech optimization and integration of digital technologies in use in healthcare leads to synchronization of data and improves its quality based on which the right business decisions can be made. Data and its analytics show up problems clearly and that is the first step to solutions. Incorporating AI and ML could further automate intelligent analytics and give predictive capabilities in decision making. Here again you could get RCM experts to update existing RCM software with these inclusions.
To sum it up, tech optimization of the revenue cycle management process, given the current scenario needs to address core issues such as:
- Revamp or modification of the revenue cycle management process and also the software
- Fine tune RCM billing system and tie it together with lateral and vertical solutions like medical records and insurance clearing houses.
- Fine tune the existing RCM system to maximize ROI
- Incorporate analytics, AI/ML and predictive capabilities to empower intelligent decision making.
- Keep measuring gains such as successful claim submission and payment rates and speed of cashflow as well as reduction of outstanding.
Optimization of a hospital revenue cycle management also requires the right mindset and the need for appointing an administrator to oversee the process, one who is conversant with technologies and can work in collaboration with RCM experts to take it forward. For startups, it is relatively easy: they can engage revenue cycle management consultants to get off on the right foot but for existing healthcare services that currently use diverse solutions it takes a little bit more time and effort but it is well worth it.
Boost hospital revenue cycle growth by advancing overall efficiency through tech optimization. Call in OmniMD experts for tech optimization and see the results that ensue.
What Is Revenue Cycle Management, and How Does It Benefit Health Organizations?
Health organizations may seem to generate positive revenues based on paper records but how much of it is actually realized and the speed of cash inflow tells the story of its financial health. Revenue collection can be negatively impacted by poor coding, errors in billing and delays or denials by insurance companies. Most of these and other deficiencies can be overcome and addressed by the use of revenue cycle management solution.
What is revenue cycle management?
Revenue cycle management (RCM) is a process, usually a part of EMR or EHR systems used by healthcare services. It is comprehensive in nature, ranging from scheduling appointments to registrations to giving a cost estimate to tracking a patient’s treatment to billing, recovery and follow up.
With covid-19 pandemic hitting the healthcare systems on a global level, about 75% of healthcare facilities implemented RCM to continue serving the patients despite quarantine and social distancing measures.
RCM software delivers proven benefits not only to patients but to the healthcare service providers as enumerated in the following paragraphs.
The revenue pitfalls in healthcare services
Healthcare organizations need a steady and healthy cash flow in order to meet expenses as also for future expansions. However recovery of dues is not 100% guaranteed due to various factors:
- Not collection complete information from the patient as regards health condition and insurance coverage,
- Disputes arising due to misunderstanding about patient’s expectations of cost of treatment and actual treatment,
- Delays and denials by insurance companies in settlement of claims, and
- Changing laws and regulations.
The RCM System addresses these and other issues and when incorporated as part of medical appointment software or plugged into EMR/EHR, can considerably reduce outstanding and improve transparency, reputation of the healthcare provider and also give satisfaction to patients.
RCM enables streamlined collection of data
Healthcare service providers may choose to outsource this work to a revenue cycle management company but it makes good sense to have this process in-house. With revenue cycle management integrated into existing software solutions such service providers can streamline processes such as:
- Schedule an appoint
- Register a patient
- Collect patient data such as health and medical records and vital insurance papers and check about claims admissibility
It is vital for healthcare providers to collect patient’s medical records in order to know the line of treatment to be initiated and costs involved and to also know just how much of these costs can be covered by insurance and how much the patients will have to bear. It is wise to give patients a clear indication of their part of financial burden rather than spring surprises later on after the treatment is over.
Revenue cycle management can use this data and the RCM software to:
- Record treatments and associated costs
- Raise bills and submit claims to the insurance provider using the right codes to record them so as to avoid denials
- Follow up for recovery of dues, send reminders and collect payment from patients and also from insurance and to refile claims in case of denials. If insurance is denied outright then amounts may be recovered from patients through the automated software. Insurance can be a very sticky point and errors here can lead to misunderstanding with patients and also loss of revenue by way of denied claims. Automation, fine tuning and reminders in the RCM greatly improve the insurance part of the process.
Considering that not all healthcare providers are the same in the method of operation or size, they may need custom RCM systems in the selection of which suitable revenue cycle management consultants can be of great help. They can assist in selection of the RCM software and also to set up best practices for revenue cycle management.
Benefits of Revenue Cycle Management Solutions to Healthcare Providers
Engage revenue cycle management consultants to choose the right revenue cycle management solution and have them set up the RCM system to suit your particular method of operations. You may need to have the RCM software integrated into the medical appointment software, which the software provider can carry out. The first step is creating awareness about the importance of fast cash flow and encouraging use of the software by personnel who must be given training in the use of RCM solutions.
This leads to systematic benefits as given below.
RCM streamlines the connection between health records, treatments and accounting system through integration. You have single point view of the financial health, billing, bad debts, receivables and claims (in process, disputed, and denied).
Better, faster and higher recovery
Recovery from insurance is a sore point and by reducing errors of coding and filing claims under the right head, the software improves recovery rate and reduces percentage of denied claims while also issuing alerts about refiling within the stipulated time, thanks to efficient revenue cycle management systems.
Simplify tasks, automate them and reduce workload
The RCM solution simplifies tasks, reduces work loads, reduces margins of errors and provides a single window access to all records and facility for follow up for recovery. The RCM software reduces burden, time and efforts.
Single point access to all patient records
You have all patient records and related financial records in one place giving all vital information at a glance.
Fingertip analysis and generation of reports
Streamlined and integrated data can be analyzed quickly to derive insights about revenue flows and state of financial health of service providers, thereby enabling timely action. Knowing your financial condition can help you to take corrective action to reduce debt and speed up cash flow.
Create a better impression, improve relationships and generate more business through referrals
By being open, transparent, honest and upfront about treatments costs the healthcare provider creates a better impression in the minds of the patients, leading to more referrals and recommendations.
Healthcare is infinitely more convoluted and complex than cash and carry businesses. Healthcare is a business in a manner of speaking, relying on healthy revenues for sustenance and growth. The right revenue cycle management solution makes a world of difference to financial health of providers as well as patient relationships. It is advisable for healthcare providers to choose RCM software with care and also have it implemented by RCM consultants/solution providers in order to make the best use of it.
Let the RCM software improve healthcare services through real-time data management, accurate records, and reduced fallacies. Opt for RCM software now!