Why is Healthcare Revenue Management Cycle so complex?
Time management and efficiency play a significant role in RCM. How a practice uses EHR can be largely centered on how their RCM is implemented. For most healthcare providers, RCM is present from pre-registering a patient till the payment collection. Whether you own multi-location practice or a single-location, revenue cycle management has become a fundamental component for all the healthcare providers.
The revenue cycle management services (RCM Services) in healthcare is a multi-step process. It starts with providers submitting their patient documentation to the RCM vendors or in-house staff, then the claims are submitted and adjudicated by the payor. If the claim is denied its efforts should be taken to adjust, resubmit the claim before the deadline. If there is a patient responsibility portion, then the patient billing cycle begins.
A complex business interaction with patients is represented by the revenue cycle. It includes insurance verification and both point-of-service and after-service collections. Mismanagement at any level can damage score and reputation of your practice. Therefore, about 92% of the hospitals have shifted their focus to revenue cycle management technology.
Why the Revenue Cycle Management(RCM) still so complex?
ICD-10 codes continue to demand attention ahead. Keeping up with ongoing ICD-10 changes, the practices and hospitals have to battle due to lack of knowledge about the system. The challenges are intensified as health systems, hospitals, practices try to amend to an environment that requires more robust documentation. Still the efforts are made to bring the practices and their staff as close as possible to the revenue cycle updates and avoid delayed or unpaid reimbursements.
Patient Access have focused on technology as an opportunity to improve patient engagement, now the revenue cycle management teams will drive technology advancements for more efficiency when it comes to billing and payment. The enhanced capabilities in portals; kiosks; and other channels gives flexible payment arrangement capabilities. Many organizations make communications between patients and customer service departments easier — allowing for quicker resolutions.
Compliance — the continuous regulations is impossible. The healthcare is to receive an ever-changing portion of national political attention, the focus on compliance is at all-time high. The practices will be overburdened with the complexities of the ever-changing healthcare regulations. This will make the practices/hospitals to look for outsourcing their technical and billing activities. Thus, shifting the burden of creating strategies for their practice and implementing them. The practices will be able to focus internally on creating a culture that fosters compliance.
How to Have a Successful Healthcare Revenue Cycle Management?
Consolidation — there could be potential loss due to the transitioning of the focus from emergency services and hospital stays to outpatient and ambulatory care. But, revenue cycle leaders/vendors make sure their workflows are properly mapped to existing platforms and any other shift that can be tracked and reported.
Next-level RCM — now the RCM teams will be looking to identify cost efficient opportunities and generate stronger cash flow. So, outsourcing to professionals who already have access to the targeted talent are needed. The Revenue cycle services help to reduce the complexities of the revenue cycle at every level.
The past couple of years has proved to be challenging for the revenue cycle leaders. The changes in the healthcare industry have come fast and furious such as new regulatory demands, increased pressure from payors and ongoing market consolidation. Also with value-based care penetrating deeper into the industry, there is uncertainty always looming about the future of all practices. The near-future will continue to test revenue cycles of the practices as well as bring new opportunities.
iPatientCare’s Revenue Management Cycle is up-to-date and well managed by experts. They take care of the complete financial cycle of the practice, so that the providers can pay attention to their patients.
About Author: Jessy Browne cherishes writing on varied subjects. She is a versatile writer who recently is affiliated with a company that provides healthcare revenue cycle management services(RCM Services). She is passionate about writing articles on financial and documentation management of practices.
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