Medical Revenue Cycle Management
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Eligibility Checking
Customized Scrubber Checks
Claims Processing
Build Customized
Scrubber Checks
Claim Follow-up to Ensure Payer Acceptance
Posted Updates on Insurance, Patient Payments and Denials
Denials and Appeals Management
Processing Patient Statements
Designated Call Centers to take Patient Calls
Dedicated RCM Client Service
Healthcare Revenue Cycle Management
PrognoCIS RCM combined with PrognoCIS EHR and Payment Collections creates a simple, single source for managing your Revenue Cycle.
Revenue Cycle Management Process
Healthcare billing is unique because bills and claims are processed over a prolonged period of time, often going back and forth between payers and providers for months. When this is combined with patients who might not have immediate means to pay their bills, healthcare revenue cycle management becomes critical.
By breaking down each patient visit into a silo and streamlining the data into a clinical repository, it is easier for practices, providers, patients, and payers to understand what happens at each step, reducing the time spent in processing information, reducing denial rates, and increasing revenue margins.
Key Considerations of RCM
Real-time eligibility verification is done even before a patient visits the facility. This is a great way to help reduce the risks of rejected or denied claims that can come when a medical practice accepts the information provided by the patient alone
A clean claim is one that was processed correctly by a Health Facility and reimbursed by the payer on the first submission. When assessing the effectiveness of a Revenue Cycle Management System, it’s important to determine the percentage of clean claims while uncovering the causes of those that were unsuccessful. By monitoring trends, you can identify areas of weakness in the current system moving forward. With PrognoCIS claims are automatically generated saving time and reducing delays. PrognoCIS has a 96% clean claim rate.
Key Performance Indicators (KPI) help physicians and management understand the strengths and weaknesses of their revenue cycle and help guide future decisions. They also help prioritize resources and recognize key success drivers. Here are some of the Key Performance Indicators of successful revenue cycle management for facilities that PrognoCIS implores.
When evaluating revenue cycle management, it’s crucial to consider the gap between the date of service and the date billed. In many cases, filing dates are delayed due to coding errors, incorrect insurance information, or other mistakes on the part of the staff. For example, using an outdated code generally results in a claim being denied automatically. This issue can cost the company money and time in the long run.
Reimbursement Turnaround Time refers to the amount of time it takes from the time the claim is submitted to receive reimbursement. If your facility is filing accurate claims, your turnaround time for reimbursement should be relatively quick. On the other hand, practices that lack effective revenue cycle management may experience significant delays in getting paid.
By tracking this data, hospitals and health facilities can take steps to rectify inefficiencies while improving communication strategies with insurance companies that are typically slow to pay.
Claims denials are a fact of life in the healthcare field. However, by adopting efficient revenue cycle management, medical practices can take steps to boost profitability. Some of the numbers to consider include:
- Percentage of denied claims (both overall and by the payer)
- Percentage of denials by category
- Percentage of no-response claims
The goal is to reduce the number of denials that result from practice errors as compared to the payer errors.
One of the benefits of effective Revenue Cycle Management is that it allows Health Providers to automate claims filling and support timely filing. By requesting payments as soon as the encounter has been completed, you boost the odds of successfully collecting the debt.
Health Providers often lament the fact that they aren’t collecting larger percentages of their accounts receivable. As a Healthcare Provider, it’s important to determine how much money you’re collecting compared to the amount billed. Additionally, you can divide total accounts receivable by average daily charges to determine the days in AR. Generally, an account receivable of 120 days or more is indicative of problems with your RCM.
Our billing reports help you gauge the expected revenue
Enhance your Revenue Cycle Management with PrognoCIS
Our Medical RCM solutions helps Monitor your Daily Charge, Identify any inconsistencies, and manage your overall Practice Revenue.
