Essential Steps to Follow in Revenue Cycle Management

The revenue cycle is an integral part of any healthcare organization. The absence of an efficient revenue cycle management system could result in a healthcare practice losing thousands of dollars in inpatient payments, reimbursements, and other promising revenue streams. Suffice to say; a healthcare practice cannot hope to survive, let alone thrive, without a robust RCM system.

Understanding the intricacies associated with patient revenue cycle management is fundamental in handling the process efficiently. Just like any other process, RCM also consists of a few vital steps that must be followed diligently for the healthcare organization or practice to succeed. 

Revenue cycle management incorporates the entire revenue cycle, right from appointment to the eventual moment when a patient’s bill is paid in full. So without much further ado, let’s look at the essential steps required to manage revenue cycles effectively and efficiently. 

1 – Pre-Authorization/Verifying Eligibility

The very first step in RCM is registration and pre-authorization. You must gather a patient’s insurance and financial information to proceed further. This step can be improved by implementing fully integrated medical billing tools that facilitate pricing transparency and insurance verification.  

This step can be further improved by having an automated eligibility verification tool in place. The device can help save time by instantly providing insight into how the healthcare organization will be compensated for its services. The device also helps patients by reminding them of their financial responsibility. 

2 – Charge Capture

Charge capture is the second step in RCM, wherein the services rendered to a patient are transcribed into billable charges. This is the moment when a medical billing code is assigned to the claim, thus making it an essential part of claims processing. You can code more accurately by employing credible RCM software that gives you access to imperative coding tools. Accurate coding will result in timely reimbursements. You can also save tons of money on administrative costs associated with claim re-works by simply using a claims scrubbing tool to ensure each claim is coded accurately the very first time. 

3 – Claims Submission and Managing Denials

After you are done with charge capture, the very next step is submitting the claim. Accurately coded claims must be submitted to the payer to ensure timely reimbursements. It is imperative to submit clean claims to prevent claim denials. You can improve this process by employing practice management software. 

With the help of such assistance, you can track your claims in real-time. You can also stop them before they have a chance of being rejected if you believe the submitted claim has issues. Make sure the accuracy rate of your claims is as high as 99% if you seek faster compensation for your services. This can be achieved by implementing medical billing solutions that identify and notify your team of any coding errors in the claim. 

Suppose you can’t afford a practice management software or don’t know how to use it. In that case, you can outsource the RCM process to a reputable vendor who harbors the technology mentioned above and can take care of the claims submission process capably on your behalf. 

If a claim is denied, a billing partner and the right software will help you rectify and resubmit the claim as quickly as possible. 

4 – Payment

The patient’s insurance provider reviews the submitted claim. Once reviewed, the payment will be released to your healthcare organization. You can improve the payment process by implementing a billing solution that allows patients to view and pay their bills via a robust patient portal. The answer can also send scheduled reminders to patients and prompt them to clear their dues as soon as possible. The hired third-party medical billing partner can also help establish quality collection services to ensure payments are on time and complete. 

5 – Reporting

Typically the RCM process is complete once the payment has been recovered. However, it is also essential to have access to quality reports that give insight into the entire revenue cycle management system. These insights can devise strategies to avoid mistakes associated with the RCM process in the future. The reports will help you find out the areas that need improvement in how RCM was performed to ensure you are not losing money. Your billing partner can help you reduce time in A/R by identifying roadblocks in the revenue cycle with comprehensive reporting.  

Outsourcing to DENmaar for Hassle-Free Patient Revenue Cycle Management. 

It is also important to note that managing a revenue cycle can be tedious and time-consuming. Spending hours sifting through patient data can be frustrating for staff members who are also responsible for other healthcare organization or hospital administrative tasks. An overburdened staff can commit errors that ultimately affect the overall quality of an RCM process. 

As such, a fundamental step in revenue cycle management also involves the question of RCM outsourcing. A healthcare organization must decide whether they want to outsource RCM services or take care of them in-house. In hindsight, outsourcing RCM to a reputable medical billing company has proven to be a cost-effective and time-efficient practice that has immensely benefited many practitioners, hospitals, and healthcare organizations. 

Outsourcing is a wise practice to consider if healthcare organizations seek to maximize their profits and drastically reduce the burden of patient revenue cycle management. DENmaar is one such medical billing company with an impeccable reputation when it comes to the rendering of quality RCM services. 

We at DENmaar are insurance billing experts. Together with our robust RCM software makes DENmaar more than capable of not only managing your entire revenue cycle efficiently but also helping your organization succeed with a fully optimized medical billing system. Get in touch with us now to know how DENmaar can help you with your medical billing processes.