Guide to Contracting Out Your Revenue Cycle Management
In an ideal scenario, the practice of healthcare would consist solely of one-on-one encounters between a doctor and a patient. The doctor would charge the patient for the services provided, use the money to buy supplies so he could keep practicing, and then the cycle would start all over again. Of fact, this hypothetical situation is hardly more than an extremely simplistic perspective of our current, outdated healthcare system.
The doctor-patient relationship is no longer the only consideration when it comes to providing medical treatment today, whether out of necessity or on purpose. Instead, we’ve established insurance companies and government programmes to enable providers to offer care to those who might not otherwise be able to afford it and to guarantee that doctors are paid for their services. While doing so, technological advancements have made it possible for us to deliver higher standards of care and more complex procedures than ever before.
These incidents, along with several more, helped to shape healthcare into the vast yet complex system it is today. While many of these regulations were put in place to provide security, essential supervision, and accessibility for both patients and providers. They have also resulted in the addition of a number of new steps to the medical treatment process.
It’s not surprising that the expenses of obtaining healthcare and the costs of providing healthcare have increased in tandem given that the overall cost of healthcare is predict by the CMS to reach $6.0 trillion by 2027. A crucial question still remains. How do healthcare operations manage the delicate balance of managing more procedures, more providers, more regulations, and more money than ever before, all while keeping a handle on expenses coming from within the office?
Provide online points of contact
Information on patients should be easier to get, not more challenging, by getting services from Healthcare RCM Companies. You’ll boost engagement and lessen the effort on your staff if your patients can input critical information on their own to make changes to their records, request an appointment, or submit demographic updates before the revenue cycle starts.
What is Revenue Cycle Management?
The procedure utilized by healthcare businesses to follow each patient care case through each stage of the relationship known as revenue cycle management, or RCM. Revenue cycle management strives to consolidate all financial information pertaining to each patient into one location, starting with the initial registration and appointment scheduling through the actual treatment and service provided, then through the billing cycle. By offering a platform to manage treatment and healthcare data together with administrative information like their name, billing information, insurance provider, and more, RCM therefore integrates both the clinical and commercial aspects of a practice.
Tips for Revenue Cycle Management Success
You’ll want to make sure you do it correctly because the purpose of revenue cycle management is to provide clarity and accessibility at all stages of the revenue cycle, allowing you to gather vital information regarding gains and losses at each stage of the process. Good RCM can be the difference between a successful business and a struggling practice for all the reasons outlined throughout this article so far as well as variables that may be unique to your firm, such as increased competition and state laws. RCM can help tighten the budget and look for leaks because the cost of billing and collecting money from patients in the healthcare sector is over $250 billion annually.
Patient registration
Usually, the service provider will enter all patient data, including financial, insurance, and demographic details. The service provider will also validate the proposed medical billing businesses procedures and give insurance verification.
Conduct a complete pre-registration
Contact each patient by phone or email before the appointment. If you’ve met the patient before, ask for updates for any information that may have changed since the previous visit. Also, ask for a complete list of contact information, insurance information, and updates for any information that may have changed. Remind the patient that payment is due at the office if there is a copay for the forthcoming visit.
Create an enrollment check list
Give the patient a second chance to update the records your office has on them on the day of the appointment. You can avoid wasting time and money later on with denials if you prevent insurance delays now. Verifying the patient’s identity and demographic data at each visit, having a copy of the patient’s insurance card on file, and asking the patient whether their insurance information has changed at each visit are a few of the essential items on your registration checklist.
Address disputed allegations right away
Establish a deadline for resolving all claim denials. Missing a deadline can lead to yet another denial because most contractual payers have their own deadlines for submitting appeals or modified claims. These secondary refusals are frequently challenging to reverse.
What Is Outsourcing Healthcare Revenue Cycle Management?
Although streamlining communication and combining the administrative and clinical aspects of a business is the ultimate goal of revenue cycle management, starting the process can be anything but straightforward. In fact, than ever before, you’ll be collecting more information, putting in place more protections, and requiring more double checks. Due to the need for true management and communication simplicity, almost two thirds of healthcare organizations presently outsource their RCM requirements.
The same Revenue cycle management duties you’d ordinarily carry out with your own team are accomplish through outsourced Revenue cycle management, but some or all of them given to a different company. A trustworthy outsourcing company provides a reasonable, cutting-edge billing platform, offers assistance before, though, and after the cycle is over, and upholds HIPAA, ISO 27001, and 9001 compliance. Generally speaking, outsourcing your Revenue cycle management needs should reduce your overall administrative workload and boost the effectiveness of your business.
Medical coding
Service providers frequently educate people about the most recent standards due to the government and the healthcare industry’s ongoing change in rules. This comprises the most recent iterations of the CPT and ICD coding standards.
Payment posting
Revenue cycle management companies typically provide reasonably quick payment posting into your billing system. Your Revenue Cycle Management company can provide auditing and analysis of all payment data following completion of payment.
