Healthcare firms across the globe face the challenge of profitability and sustainability. The wake of the recent COVID-19 public health emergency is a concerning matter. The declining reimbursement rates have forced medical practices to pressure not only to increase efficiency in care delivery but to reduce the expenses associated with billing, submitting claims and getting paid. The challenges and high turnover for on-staff billing are a practical part of hospital revenue cycle management.
Revenue cycle management
RCM is a process that manages claims processing, payment and revenue generation for healthcare firms. There's an automaton in the claims review and submission process. The revenue cycle starts once the patient's appointment is made. It must end when the charges for the visit have been paid in full, both from the payer and the patient.
Here, the success and the failure of a healthy revenue cycle depends on what happens between the scheduling of the appointment until the bill gets paid, both by insurance and the patient.
RCM vs Medical billing
With the hospital revenue cycle management over traditional billing, there's an aggressive claim denial and claim rejection process. The RCM team relentlessly follows up on every denied and underpaid claim.
The medical practices billing staff are overwhelmed with day-to-day billing and posting activities. As a result, the time and effort required to track down every underpaid or denied claim just aren't available, resulting in providers not being paid.
KPI
The most critical metric in evaluating the practice's financial health is Days in A/R. The average number of days it takes a claim to be fully paid. Nationally the number of days in A/R has been steadily increasing since the early 2000s. Outsourcing hospital revenue cycle management helps reduce the practice days in A/R.
Why is RCM important?
Enhanced cash flow
RCM is the core of a practice's overall financial health. The quicker you get paid, the healthier the practices of business operations. If the days in A/R are greater than 40, it's time to focus on and improve the performance.
You must know that any delay in payment substantially impacts the cash flow. Therefore, minimizing A.R and claim denials are key to enhancing your revenue flow.
Lesser claim denials
Your hospital revenue cycle management starts with filing clean claims with payers. It's all about meeting all of their ever-changing requirements. Office billing staff are aware of the change only after a claim gets rejected or denied. RCM providers are updated about the changing rules and ensure highly first pass rates of the claims. Clean claims mean there's quicker cash flow.
All denied and underpaid claims
You must ensure that fewer claims get denied upfront. Moreover, it's essential for the hospital revenue cycle management process. But, you'll come across payers who deny some claims and underpay others. A busy billing staff typically doesn't have time to work all of them. An outsourced team will include a large staff dedicated to aggressively following up and operating these to ensure you paid every dollar due.
Claim submission
The timely filing of a claim is a significant part of the process. However, if there's slackness in timely filing, you must ensure that claims are denied, resulting in lost revenue. The hospital revenue cycle management will ensure that all claims get submitted as fast as possible, resulting in no claims not paid for a lack of timely filing.
Lesser billing errors
The vast array of different payer rules and complexity of medical billing in general result in opportunities for medical billing mistakes and errors. Every step in the revenue cycle, from eligibility to submission, payment posting and statement generation, has potential errors. Partnering with the RCM provider helps result in fewer errors. This leads to translating into faster cash flow.
Lower costs
You must work with a proven and experienced RCM provider for all your practice's financial health. In addition, maintaining an office billing staff can be expensive in terms of salary, turns over, training new hires and dealing with vacation, sick time etc.
A professional hospital revenue cycle management team never needs retention, takes a day off, or shows up late.
Improved patient care
Medical billing can be frustrating. Complex and changing rules lead to poor financial results and excessive time away from what's important-patient care. Outsourcing customer service in the healthcare industry allows providers and staff to focus solely on delivering exceptional patient care. Outsourcing the medical billing to an RCM partner will enable providers and staff to focus exclusively on providing excellent patient care.
Conclusion
You have earned money and must achieve a faster, more efficient revenue cycle. You need to work with a trusted RCM partner who helps the provider's revenue and minimizes the time spent on tedious and costly administrative functions. The revenue cycle management focuses its resources on providing excellent and efficient patient treatment.
For more about revenue cycle management, you can practice the current process. Vital Solutions can help you with all your debt collection.
