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Revenue cycle management procedures and their role in the business

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Revenue cycle management procedures and their role in the business

Successful healthcare companies rely on revenue cycle management. If the billing department is not up to date, the clinic can lose thousands of dollars in refunds, patient payments, and other sources of income. Understanding and implementing hospital revenue cycle management is vital to the achievement of the goal of profitable business.

The following is an overview of the revenue cycle steps and the benefits of good revenue cycle management.

Revenue Cycle Management: Hospital RCM is the entire physician’s revenue cycle, from patient retention to service reimbursement. This includes deciding whether to outsource RCM services to authorized providers and install integrated software. To perform exercises more efficiently, allow you to choose which features are important to you, and help you maximize your profits.

 Step 1. Pre-approval and verification of eligibility 

 Pre-approval and registration are the first steps in revenue cycle management. In this phase, you enter patient insurance and financial data. Automated eligibility verification systems are currently helping patients by educating them about their financial responsibilities. Assist your provider by showing you how to receive rewards for a particular service. Price transparency can improve this step in the hospital revenue cycle management process. Insurance verification technology is integrated with medical management and  billing solutions.

 Step 2: Charging and operation

 The second phase of revenue cycle management is to convert the services provided into billable charges called toll collection. This step of revenue cycle management is essential to the billing procedure from medical coding to billing. Reliable medical billing software gives teams’ access to key coding tools that can help improve coding and ensure quick refunds. Assertive scrubbing technology ensures that each assertion is encoded correctly first. This saves hundreds of dollars in rework and management costs associated with bill denial.

 Step 3: Rejection management and complaint filing

 Claim filing is the next step in managing the revenue cycle. After completing the toll collection process, it is up to you to send the correctly coded bill to the payer. You can improve this step in the revenue cycle management process by using medical care management software and RCM service providers to track your bills in real time and stop them before they are rejected. With denial management and bill filing, companies can clean up bills at  up to 99% and achieve the fastest payments possible. You can automate this task by outsourcing your bill to your RCM provider using the appropriate medical care management solution. This gives the team the peace of mind that the bill is directed at the payer. If your claim is rejected for any reason, your provider and billing software should work together to allow you to resend your claim as quickly as possible. 

Step 4: Payment

The payer payment will be on its way once the patient’s insurance has processed your claim, and you must post the out-of-pocket amount for the patient to pay. Your patients may view and pay their bills in their patient portal with an integrated billing solution. Additionally, your integrated practice management solution notifies patients about their invoices and pushes them to pay, resulting in more on-time and in-full payments. This step must contain quality collections facilities from your RCM service provider, which will advantage you to enhance patient payments while also receiving your patients on the road to rescue from health obligation. 

Step 5: Thorough Reporting

While collecting money is the final step in the revenue cycle management process, your practice also requires excellent reporting systems to help you stay on track and avoid costly mistakes. Quality reporting options in your medical billing software can assist you in quickly identifying frequent revenue cycle management issues causing money to be lost.

Key Take-Aways

Removing the loopholes in the revenue management cycle to improve your profitability and productivity is important. You can also hire a medical billing company to keep your revenue management cycle smooth.