Revenue Cycle Management

Optimize your returns and shorten your revenue cycle. Schedule a consultation with us for a FREE custom analysis of your practice’s medical billing

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Customized Scrubber Checks

Claims Processing

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Denials and Appeals Management

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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 by Numbers

Table of Contents

Benefits Of Revenue Cycle Management

There are extensive benefits when practices integrate their EHR System with Revenue Cycle Management. These include:

Improves Cash Flow

Revenue Cycle Management saves money by increasing the success rate of every claim, reduces the frequency of denied claims, and improving the overall collections.

Time-Saving

Medical RCM Services can help Healthcare Providers save time by streamlining the Financial Process of their Medical Practice helping them to focus more on Patient Care.

Error Free Claims

Focusing on the Front-End Processes, reduces errors made in the beginning which could impact the Claim Processing helps the success rate and increases reimbursements.

Improve Workforce Efficiency

Revenue Cycle Management is a financial process that s utilized throughout multiple Healthcare Systems in the United States, to help organize their finances for greater Practice Efficiency and Patient Care. The Revenue Cycle starts from Patient Registration to the Final Payment of Medical Bills.  

In this manner, Medical RCM allows Physicians and staff to handle everything from Pre-registration, selecting the appropriate ICD-10 codes (which guide reimbursement for specific treatments), complete Charge capture duties which translate documents in billable fees for creating a claim that is ready for submission.  

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.

Webinar: Ten Key Financial Reports for Successful Practice Management

Join our Medical Billing experts as they discuss the 10 key financial reports to assist your practice using PrognoCIS Medical Billing Services. Jump to the key points listed below or download the 10 Key Financial Reports for Successful Practice Management Webinar Slides.

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Request your FREE Custom Medical Billing Analysis from PrognoCIS today to see how much your practice could be saving. When you sign up for PrognoCIS Medical Billing Services, we also offer you a comprehensive package of our Premier features, including:

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