Healthcare Revenue Cycle Management from ‘Patient -to-Payment’
What is Healthcare Revenue Cycle Management?
Healthcare Revenue Cycle Management (RCM) is a process by which the hospitals carry out their administrative and clinical from diagnosing the patients to payment collection. In other words, RCM is a financial process encompassing the end-to-end model of a ‘patient-to-payment’ system, either in an automated or semi-automated platform.
Although the healthcare sector is service-oriented, it should be financially strong to provide proper care and advanced treatment methods to the patients. This is where RCM pitches in by providing a reliable system for revenue generation.
What does ‘Patient-to-Payment’ denote?
At a macro level, RCM includes scheduling a patient’s appointment, entering his/her details in a computer, treating the ailment, verifying the insurance claims, and then carrying out payment procedures.
However, each of these involves further micro-level processes for the cycle to operate smoothly.
Steps involved in ‘Patient-to-Payment’ RCM
Any process involves a series of steps for effective functioning. The same applies to this end model. Let us see them below.
Step 1: Patient Registration (front-end work)
- Employing an RCM Software
Softwares are available on the market to reduce the hassle of collecting, compiling, assessing and evaluating the patient’s information. Based on the volume of the patients and the medical field, suitable revenue cycle management software can be employed.
- Demographic Information
When a person approaches the hospital or clinic for the first time, his entire history is obtained. These include:
− personal details such as photo, date of birth, social security number, address, etc.;
− financial details such as the nature of the job, place of employment, annual income, etc.;
− past medical history;
All these data are fed into the RCM system. The patients are provided with a member id to edit, view, and change the details.
2. Scheduling
The nature of the patient’s illness is assessed, and appointment with a specific doctor is fixed, based on both their availabilities.
3. Insurance Claims
It is imperative to gather data on the insurance claim. The nature of claims differ and in many cases, the patient themselves are not aware of this, which in turn leads to payment issues at the end. Therefore, the validity of the claims should be checked prior to admitting the patient.
