Revenue Cycle Management
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Healthcare Revenue Cycle Management
Table of Contents
Revenue Cycle Management by Numbers
Revenue Cycle Management Solutions
There are a number of growing challenges facing the healthcare industry today; however, there are solutions available when it comes to patient care and managing finance. One such solution is called revenue cycle management (RCM). When it comes to software that helps with medical revenue cycle management, there are a few key points to keep in mind.
Improve Workforce Efficiency
Revenue cycle management is a financial process that is 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, scheduling appointments to the final balance payment of medical bills.
In this manner medical RCM allows physicians and staff to handle everything from pre-registration (creating a patient account that includes medical histories and insurance coverages) to creating the submission of a claim via ICD-10 codes (which guide reimbursements for specific treatments), and complete charge capture duties, which translate documents into billable fees.
There are extensive benefits when practices integrate their EHR (Electronic Health Record) System with revenue cycle management. These include:
- Time-Saving: Medical RCM can help healthcare providers save time by streamlining the finances of their medical practices helping them to focus more on patient care.
- Improves Cash Flow: Saves money by increasing the success rate of every claim, reducing the frequency of denied claims, and improving the overall collection.
- Error Free Billing & Claim: Focuses on front-end tasks, reducing errors made in the beginning and carried through to the end, which would otherwise impact the success rates of claims reimbursements.
By leveraging the benefits of RCM, providers can eliminate traditional methods of collection, helping them enhance their revenue margins and focus on a value-based system.
The Growing Challenges in RCM
There are a number of challenges facing healthcare institutions today. Some of the top challenges include:
- Billing Errors: Often, mistakes are made in the first few steps of account creation, which get carried through to the claims submission steps, leading to claims denials
- Resolve Claim Denials: With everything from improper ICD-10 codes to missing signatures on patient charts, physician RCM addresses all of these issues quickly, reducing claim denials
- Regulatory Compliance: Without medical revenue cycle management, practices have issues complying with key regulatory standards such as HL7 and HIPAA, placing their patients’ information at risk
Medical Revenue Cycle Management can leverage data analytics and health IT solutions to create more transparency in healthcare costs
These are just a few of the reasons why healthcare providers and hospitals need to invest in outsourcing their RCM services.
Revenue Cycle Management Process
Healthcare revenue cycle management 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
- Key Performance Indicators (KPIs)
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.
- Gaps Between Actual Service Dates and the Dates Claims Were Filed
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.
- Percentage of Clean Claims
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.
- Reimbursement Turnaround Time
A reimbursement rate refers to the cents on the dollar that a healthcare practice receives on a claim as compared to the amount that was billed for the service. If your facility is filing accurate claims, your turnaround time for reimbursement should be relatively quick. On the other hand, companies 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.
- Denial Trends by Payer
Claims denials are a fact of life in the healthcare field. However, by adopting efficient revenue cycle management, hospitals and doctors’ offices 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.
- Monitoring Insurance AR
One of the benefits of effective revenue cycle management is that it allows health providers to automate claims filling and avoid timely filing. By requesting payments as soon as the encounter has been completed, you boost the odds of successfully collecting the debit.
- Monitoring Percentage of Money Collected Against Charges Billed
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.
Enhance your Revenue Cycle Management with Prognocis
If you are looking for the best solution then look no further than Prognocis. Our medical RCM solutions and methods have been clinically tested and proven to be effective.
Webinar: 10 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.
EMR: Daily Collection by User (3:08)
Average Reimbursement by Code by Insurance (6:47)
Charge Reimbursement Report (8:40)
Billing: Daily Collection Report (11:43)
Groupable Billing and Collection YTD (13:27)
Waterfall Report (15:25) and AR Rollover Report (17:48)
Denial Report (19:09)
Copay Deductible Collection vs. Resp-Detail (21:10)
Insurance Paid less than Contract Amount (22:10)
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PrognoCIS Medical Billing Services offer account resolution to manage your billing. Our partners at Transworld Systems will work with you to contact patients to settle statements. Learn more about Medical Account Resolution Services.
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