In healthcare,Revenue cycle management (RCM) in healthcare is the process of tracking the revenues from patients from the appointment to the final payment of bills. Healthcare revenue cycles in the United States have a highly bureaucratic, meandering labyrinth of regulations and processes. A small misstep in any of them could delay or lose precious revenue for providers. That is why healthcare RCM services are extremely important for providers to maintain and improve their bottom line.
But there are numerous kinds of revenue cycle systems out there with as many companies offering them. For healthcare providers, it might become difficult to pick the right one that suits their requirements. A large hospital might have different needs than those of smaller practices or medium-sized ambulatory care centers. Moreover, there are different types of providers that offer varying types of medical services. Some of these include general physicians, dentists, physiotherapists, psychiatrists, chiropractors, and so forth. So, a platform for health care revenue cycle management that is suitable for one type of provider might not be as useful for another.
Regardless of which kind of healthcare organization or the type of provider, there are a few common features that are a must-have for any kind of provider. Let’s see what they are –
Eligibility Verification
This is perhaps the first step in the process of providing care to anyone. Whenever a person walks into a medical facility, the staff checks his health plan to confirm if he is eligible to receive the care that he might be prescribed. One of the most common reasons for denial of reimbursement for healthcare providers is medical services that are not covered by the health plan.
Medical revenue cycle management software with a module to verify patients’ health plans goes a long way in helping improve revenue streams. This functionality streamlines the process of verification by tracking it in real-time for private health plans, Medicaid, and Medicare. This is especially useful at large hospitals that deal with a large number of patients on a daily basis. Such a solution would speed up the verification process and avoid missing out on revenue from payers due to services not covered.
Claims Scrubbing
Filling out claims is a tedious process and is generally prone to human error. As mentioned above, this problem is exacerbated in the case of large hospitals that need to deal with lots of patients every single day. The staff at such organizations need to deal with large amounts of claims submissions, and a tiny error in a few of them would affect the revenues. In light of this, revenue management solutions in healthcare with claims scrubbing would automatically check the claims for any errors and notify the users.
Needless to say, this greatly improves the speed and efficiency of claims submission, not to mention the accuracy. As a result, staff at a healthcare organization can actually get more work done, with little to no errors.
Patient Management
Healthcare revenue cycle solutions with a patient management feature track and monitor patients’ medical information. This could include diagnosis, prescriptions, interactions, and clinical visits in an organization. When it comes to healthcare revenue management, a single consolidated repository of patient information streamlines many activities like recordkeeping, charting, appointment scheduling, claims processing, billing, and so on. This goes a long way in improving revenue cycles in healthcare by lowering administrative overhead.
Conclusion
To sum it up, there might be many features of various revenue cycle management software, but these are highly important for providers of all kinds of medical services.
