Understanding the Importance of Healthcare Revenue Cycle Management

CSuite Solutions weighs in with answers to some of the most important questions on revenue cycle management for healthcare providers. They offer insights on how revenue cycle management works as well as some of the potential challenges and benefits of a well-managed revenue cycle.

CSuite Solutions is a consulting firm that works with healthcare companies to develop effective strategies for managing their organization. They focus on the areas of population health, self-insured health plans, clinical integration and ACO consulting. But they have found that the area of revenue cycle management is often the most pressing for healthcare providers. Here they answer some of the most frequently asked questions.

What is Revenue Cycle Management, and What Does it Cover?

Healthcare revenue cycle management or RCM is the utilization of billing software specifically in the medical field to track patient-care. It is an end-to-end solution that begins with the registration of a patient and runs to the final payment of that patient’s balance. RCM joins the business and clinical facets of the business. They do this by combining administrative information such as the patient’s name and insurance provider with the treatment that the patient receives and the healthcare data that is collected.

According to the Healthcare Financial Management Association (HFMA), these are the factors involved in the revenue cycle of a healthcare facility:

  • Charge capture
  • Claim submission
  • Coding
  • Patient collections
  • Preregistration
  • Registration
  • Remittance processing
  • Third-party follow up
  • Utilization review

What are some of the challenges with managing revenue cycles?

Maintaining robust, reliable policies that are able to withstand the regular changes to healthcare regulations and the ever-updating reimbursement models are challenging. It also has a knock-on effect for payment collection at point-of-service, claim tracking and staff training.

Collection of Payments at Point-of-Service

This is challenging because of the perceived time and effort that it takes to collect payment, even though it is more efficient than follow-ups to try and extract payment. It is difficult as patients often do not have the necessary funds available to make payment upfront. There is also the risk that patients will transfer to another facility if they feel that they are being unduly pressurized.

This can be viewed at the ‘front-end’ revenue cycle management, and staff need to carefully determine Medicaid eligibility, as well as assisting uninsured patients to understand their options.

Claim Tracking

It can be difficult to track the lifecycle of a claim; it is important to be able to see where errors are being made as this can lead to lost revenue. Healthcare providers also need to receive alerts if payers regularly deny claims related to specific codes (procedures).

Staff Training

The root of many claim issues is as a result of human error from the inputting of incorrect codes, and incomplete capture of information, to patient insurance eligibility issues. It is important to prioritize education programs that emphasize correct coding and full documentation of patients.

Why is Healthcare Revenue Cycle Management Important?

It offers a number of benefits; an effective RCM system can:

  • Reduce the lag between the provision of a service and receipt of payment
  • Save time through the automation of administrative tasks such as upcoming appointments and payment reminders
  • Cut down on denied claims through prompts to guide submissions by staff
  • Provide data that pinpoints where there is room for improvement with a big-picture view of the revenue cycle
  • Cognitive computing to reduce human error and ensure correct medical codes are assigned

CSuite Solutions understands the importance of a well-run healthcare revenue cycle management. This is why they work closely with healthcare providers throughout the United States to ensure that they have an effective RCM system in place. They work with providers to actively reduce costs and ensure their clients are able to collect outstanding payments efficiently.

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