What is Revenue Cycle Management and why is it Important in the Healthcare Industry?

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Health care providers and hospitals have the serious responsibility of safeguarding the health of the general population. While it is important that they strive to fulfill that responsibility with ardor, they must also take care to maintain their own financial health. It goes without saying that a decline in their financial strength can distract their focus away from their core function. Healthcare Revenue Cycle Management addresses this need for health care systems to keep their finances robust. Healthcare revenue cycle management is the management of the financial process that helps healthcare providers manage the administrative and clinical functions related to processing claims, payment, and revenue generation. In simple terms, healthcare revenue cycle management is what helps hospitals and clinics keep their revenue flowing.

Let us now look into some fundamental questions revolving around Revenue Cycle Management in detail.

What is the Healthcare Revenue Cycle Management?

Healthcare Revenue Cycle Management  (RCM) involves supervising the entire process of generating revenue for a healthcare service provider. This process or the revenue cycle begins when a patient calls a healthcare service provider to make an appointment and concludes when the payment for the service hits the service provider’s accounts. The healthcare revenue cycle comprises administrative functions like

  • Payment scheduling and insurance verification
  • Medical coding, demo & charge entry
  • Claim checking and resolution
  • Payment processing & posting
  • Denial management
  • AR follow-up
  • Patient Statements
  • Quality & Audit

An effective Revenue Cycle Management service maintains smooth communications between the three main players operating in the healthcare revenue cycle – the healthcare service providers, payers (insurance companies) and the patients.

What are the Key Concerns in Healthcare RCM?

The healthcare industry is ridden with challenges that have resulted in the loss of billions of dollars for the industry and a hike in healthcare costs for the common man. A National Health insurer report released last year announced that healthcare organizations shoulder a loss of 5- 12% of their revenues mainly due to errors in their claims.

Lack of Training 

One minor human error like a misspelled name or a wrong code can result in time-consuming denials. However, Healthcare providers are finding it difficult to train their employees to avoid such mistakes. They need systems to manage workflows so that they can identify and rectify shortcomings in the revenue cycle. But the high-pressure environment that they work in makes it difficult to implement such systems.

Changing Regulations

Another serious concern is the constantly changing regulatory atmosphere. Government regulations in healthcare are becoming more complex each day. Recent changes like the ICD-10 have made compliance more burdensome for healthcare professionals. 

Technological Advancements

Technological advancements although they are beneficial to present a challenge to the players in the healthcare industry. Artificial Intelligence and data analytics have revolutionalized healthcare revenue monitoring systems. But to keep pace with these advancements healthcare providers have to invest heavily. Small and medium-sized healthcare establishments and individual practitioners cannot afford such costly updations. 

Why is Revenue Cycle Management  Important for the Healthcare Industry?

A good Revenue Cycle Management service can make a lot of difference for the healthcare providers in optimizing revenues. Here are some ways in which a professional RCM company can help in overriding the challenges in the healthcare industry.

 1. Helps handle the complexity of regulations

A professional RCM service company is more equipped than hospitals to navigate through the labyrinth of laws. Their teams are continually trained in the changes and updates in HIPAA and other regulations so that compliance is ensured.

 2Saves significant time and cost

Revenue Cycle Management Companies save considerable time and cost by utilizing the efficiencies they have gained through experience, automated systems, and trained resources. They pass these savings on to their clients

3. Increases ability to invest in new technologies

RCM service providers operate at a higher scale and have the incentive to invest in the latest software and advancements in healthcare RCM systems. Moreover, when such systems are used, useful data are generated. Healthcare service providers can use this data to glean valuable insights for formulating their future strategies and goals.

So if you are plagued by operational inefficiencies and dwindling revenues then a  Revenue Cycle Management Service Provider is beyond doubt the perfect fix for your problems. Rannsolve is a world-class service provider with rich experience in medical billing and all other facets of Revenue cycle management. It has been providing timely, cost-efficient RCM services for its clientele spread across the globe. Contact Rannsolve team today for a free trial service.  Rannsolve’s expertise ensures that your cashflows are uninterrupted, your revenue growth robust and your compliance efforts on the mark.

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