8 Steps In Revenue Cycle Management

Hospitals, healthcare systems, and smaller practices invest so much in keeping patients healthy and keeping them disease-free. But what about the organizations’ being financially healthy? Should they not have policies in place that will ensure financial security? In order for hospitals and medical practices to remain sustainable, they need to have structured processes and policies for staying healthy financially. Revenue cycle management (RCM) is the process through which establishments manage administrative and clinical functions associated with patient registering, processing, and revenue generation. Having structured, systemized, and coordinated processes can go a long way in guaranteeing a practice is operating efficiently and economically.

Most hospitals excel when it comes to quality patient care and timely treatment, but lack resources to follow up on insurance and collect patient service revenue. Healthcare RCM is an integral part of a practice and any fluctuations in that would severely affect the overall performance of a hospital/healthcare system. Therefore, a huge number of healthcare systems outsource these processes to companies that have experience in such matters. A dedicated team that fights aggressively to meet targets and generate maximum revenue would be an asset for practices. Most outsourcing companies, including RCM Services by Script All DNA Technologies, have eight steps that they follow to ensure proper revenue generation. Let’s take a look at each of them briefly!

1. Patient Eligibility And Authorization

Having an accurate verification process in place can not only speed things up and raise the overall bottom line, but it also drastically reduces denials. Prioritizing patient access is critical for revenue cycle management since it helps move claims along and prevents any unsolicited delays in the subsequent steps. Many companies go digital, allowing patients to verify their demographics, in order to reduce errors occurring in the initial steps of verification and eligibility to avoid lags towards the end of the cycle.

• Medical Coding

Medical coding is the conversion of healthcare procedures and processes to universal medical alphanumeric codes. Matching the codes with the respective procedure is essential to the entire RCM process since the wrong code could inadvertently result in denials. By reading the medical codes, an individual should have an idea about the patient’s encounter with the doctor and the services rendered.

• Charge Entry

An elaborate procedure that requires experienced professionals who can accurately calculate the amount of reimbursement the provider will obtain from the insurance payer. Though charge entry seems like a small part of an elaborate process, any errors here will result in bigger, impactful errors down the road.

• Claim Submission and Rejection Management

Quality testing and verifying if all the information is correct is a critical step of RCM. It is important to catch any errors prior to making a final submission.

• Payment Posting

It allows you to view payments and provides a summary of the practice’s financial picture, making it easy to spot problems and resolve problems. It included information on daily insurance payments, insurance checks, and patient payments. Incorrect payment posting will affect secondary or tertiary payers and this will reflect in the overall process.

• Denial Management

Our team has a comprehensive understanding of denial management – we understand that each case is unique, and we, therefore, implement our strategy as per the case requirements. Note that denial management is different from rejection management. Rejected claims are ones that have never made it to the payer’s system due to certain errors. Billers can correct and once again submit these claims, but this is not possible with denied claims as these payments are already checked and rejected.

• Account Receivable Management

A compilation of processes including categorizing denied/unpaid claims and approved claims, re-filling claims, and monitoring and minimizing AR days. Improving the AR process means proactively managing the steps in the RCM cycle and immediately addressing any and all inefficiencies.

• Patient Statement

Patient statement allows you to reduce your costs and save time by billing your patients quickly and efficiently through electronic billing options.

Surveys state that claim denial rates have been steadily rising over the last decade. Organizations resort to different means to tackle this – some spend hundreds of dollars in training staff on medical billing and coding processes, creating awareness of medical costs, and also investing in automated software devices that help with billing and coding. But a better and more efficient way would be to outsource these services to a firm that is already accomplished and has expertise in this field. RCM Services by Script All DNA Technologies provides one of the best RCM solutions in the market through collaboration, mutual understanding, and having the aim of working towards a common goal. RCM Services identifies new strategies and processes that can ultimately benefit the bottom line of any practice. To summarize, healthcare systems and hospitals can save a substantial amount of time by outsourcing administrative tasks and focusing on and delivering quality patient care.