What is Revenue Cycle Management or RCM ?
Revenue Cycle Management (RCM) refers to the process of identifying, collecting, and managing the company's revenue from customers based on the services provided. A successful RCM process is essential for a healthcare practice to maintain its financial strength and continue to provide quality care to its patients. The move to value-based reimbursement and comprehensive patient care has forced healthcare providers to take a closer look at the way they manage their revenue streams. Poor billing practices can result in financial losses and can compromise the ability to provide quality care. Working to improve and standardize key operating systems can help providers maintain revenue.
Financial Process Management Challenges
The revenue cycle begins when a patient makes an appointment and ends with successful payment collection. However, there are many intermediate steps that must be completed efficiently and effectively to ensure timely payment. The potential for human error due to complex transactions, miscommunication, medical billing errors due to duplicate data, and missing information or misspellings can lead to lost revenue. The health care system and the ever-changing nature of reimbursement can make it difficult to get reimbursement on time. It can also increase the time users search and often need the appropriate software technology to perform the necessary reporting. Health care providers often work with limited resources. As providers become more successful, it is often necessary to focus on improving the efficiency of administrative functions.
Factors that can affect RCM
The provider has little control over payment through the application review and denial process. Long waits for billing and claims being processed for provider payments can result from denied claims due to insurance eligibility issues and growing efforts to combat health care fraud and abuse. However, there are some internal factors that the supplier may have some control over. Productivity, patient volume and revenue collection are areas that providers can focus on improving their RCM. Issues that can disrupt the RCM process include:
Summary of patient payments
The role of the patient in medical expenses is increasing. If the patient's fees are collected during or before their services, the risk of non-payment will be avoided. Although this is often a difficult task due to the fact that many patients find it difficult to pay high fees and do not know their financial obligations.
Patient registration is key to getting the best medical history and insurance information up front to reduce claim denials. This can help speed up the payment process by collecting data about coinsurance, additional coverage, maximum number of visits allowed, and determining a patient's financial performance.
A decentralized system
The front and back of the table are usually different. Failure to share information may result in denial of charges. Improved communication during patient admission regarding eligibility for insurance can aid in the coordination of payers, reimbursement, and can improve payment collection. Focus on front-end processing services to expedite claims and help uninsured patients understand their coverage options and coverage changes. Correcting a patient's insurance information at other visits is often overlooked and can result in denial of eligibility.
Eligibility terms
Liaison with major health insurance companies. Failure to manage the claims process when submitted may result in pending, rejected, or denied claims, or those that have not yet been received. Analyzing complaints to identify the source of a problem, such as determining whether there is a problem with a specific system or code, can help increase awareness and reduce returns.
There is no digital workflow
Poor data quality and future revenue stream problems can occur without proper digital workflows. Developing a strong health IT infrastructure can help with RCM and the ability to organize relevant reports. Implementing an electronic workflow can also help seamlessly streamline back-and-forth communication and eliminate wasted paperwork.
Invest in administrative staff
Administrators who know how to work with the unique requirements of different payers can help create a more efficient billing and collection process. This may require organizations to invest in staff training on the use of billing forms, barcodes, charting, financial system software, and insurance verification. Some medical practices choose to outsource their RCM efforts to take advantage of the wealth and knowledge of dedicated partners.
Administrators and accountants play an important role in fundraising, although some may view these positions as simply collecting data. Promote teamwork and collaboration by providing coders with mentoring and other career development resources, to change this mindset, while building their knowledge base and showing appreciation for their contributions to the organization's financial success.
Benefits of a Revenue Cycle Management System
Many service providers choose to invest in revenue management (RCM) software, which is a performance management product. While other vendors may choose to issue RCM to ensure proper identification of ICD-10 codes. RCM applications can stand alone or be integrated with electronic health records (EHRs). It can help store and manage patient billing records and can reduce the time between patient visits, billing and reimbursement by integrating with other EHR systems. RCM systems can contribute to the transition from fee-for-service to value-based reimbursement by providing detailed information on patient populations. Other benefits of an RCM system can include:
- Save time by automating tasks such as appointments and payment reminders, and contacting insurers if a claim is denied.
- Provide information on why charges were not filed
- Ask users to enter information to save and review claims and get information on why claims may be denied
- Ensure that Medicare patients are reimbursed appropriately
- Determining the patient's insurance status and reimbursement requirements
- Options include error detection to help resolve and track unpaid claims
- Opportunity to review revenue reductions
RCM process management
Focusing on reviewing and improving the company's Revenue Cycle Management (RCM) core business systems can allow suppliers to begin managing the RCM process rather than allowing claims to impact the supplier's financial strength. Monitoring and early detection of registration issues can help identify eligibility issues to help prevent early application rejections, while implementing RCM software can help ensure timely refunds are received.
How Does AlohaABA Help in You ABA Billing Services ?
Ever Wondered if your ABA practice management software could help u manage your RCM process? We got you covered. Here are a few ways ABA billing services from AlohaABA can assist you:
AN INCREASE IN REVENUE:
- You will be connected to a dedicated billing manager who will follow you every step of the way.
- You don't need to worry about outstanding balances or rejections
- Our team has over 15 years of experience in ABA billing
CUSTOMER SERVICE:
- Best in class customer service and response time
- Benefit from dedicated customer success and billing management
- Free training and advice on insurance billing
DISCLAIMER AND DISCLAIMER OF WORK:
- Get instant updates using the AlohaABA dashboard
- Your billing manager will be integrated into your billing process and provide bi-weekly/monthly reports.
- It is easy to access customer account monitoring and reporting
- Apps for all tasks, including calendars, billing and notes.
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