In healthcare, revenue cycle management (or RCM) refers to all the administrative and clinical functions that contribute to the capture, management, and collection of revenue for patient services rendered.
Every step in the patient care process, from the moment an individual presents to a healthcare setting or makes an appointment to be treated, to the final step when payment for treatment is received, is a part of the healthcare revenue cycle. This means that an optimized healthcare revenue cycle management process is essential for patient care, payer satisfaction, and a financially viable healthcare organization.
Revenue Cycle Management In The Medical Billing Process
Regardless of the size, structure, location, or type of services provided, all entities within the spectrum of healthcare need to have a revenue cycle management process established to collect payment for care across four principal payment methods:
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Patient out-of-pocket
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Individual private insurance
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Employment-based group private insurance
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Government financing
There are several distinct functions in the healthcare revenue cycle that feed into effective revenue cycle management and help healthcare organizations grow and maintain their revenue streams:
Pre-registration
Collecting information, such as insurance coverage, before a patient arrives for inpatient or outpatient procedures.
Registration
Validating subsequent patient information to establish a medical record number and meet various regulatory, financial, and clinical requirements.
Charge Capture
Rendering medical services into billable charges for submission to the insurance provider and ensuring revenue integrity.
Utilization Review
Examining the necessity of medical services requested and rendered related to the patient’s healthcare coverage plan.
Coding
Translating diagnoses and procedures into alphanumeric or numeric codes and used by billers to develop patient claims.
Claim Submission
Submitting claims of billable fees to insurance companies for reimbursement or payment transfers.
Remittance Processing
Applying or rejecting payments through remittance processing in insurance and other payer organizations.
Third-party Follow-up
Collecting payments from third-party insurers as per the standings agreed upon during contract negotiations.
Patient Collections
Determining patient balances and pursuing outstanding balances through the appropriate payer entities.
Why Healthcare Revenue Cycle Management Needs To Run Properly For Healthcare Providers
Ultimately, an effective healthcare revenue cycle management process results in higher quality care for patients and improved financial health for the provider. Here are a few distinct benefits a healthcare provider can expect to gain from optimizing revenue cycle management:
Increase The Healthcare Company's Financial Bottom Line
The healthcare landscape is evolving at a rapid pace. Time and expertise are of the essence — healthcare organizations need a reliable process that enables them to optimize their revenue cycles and align with demand. An optimized revenue cycle management process can help healthcare providers:
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Meet payer and partner requirements in a timely manner
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Detect payment errors and streamline resolutions
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Track and monitor unpaid claims across channels
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Review revenue shortfalls and identify improvement opportunities
Streamline The Billing Processes
Optimized healthcare revenue cycle management helps accounts receivable teams save significant time and effort. Employees should also be able to quickly determine a patient’s insurance status and copay requirements, further ensuring timely reimbursement for Medicare patients and other care recipients.
Provide Clinical Transparency
Optimized revenue cycle management is cross-functional and provides transparency into clinical workflows to ensure thorough coding and timely billing. It shouldn’t simply alert teams when a claim is denied but facilitate insights into why it was denied and offer additional measures to save on claim revisions and prevent future rejections.
Build Compliance Into Operations
From collecting a patient's insurance information to payment collections, a healthcare provider needs optimized revenue cycle management to back its people and processes. Accurate, timely documentation will help keep an organization compliant with government regulations, and an effective revenue cycle management process ensures this by providing a workflow that is consistent, easy to perform, and trackable.
Improve The Quality Of Patient Care
Optimized revenue cycle management doesn’t just improve back-end operations but results in better patient care as well. It helps payers approve an agency’s care and reimburse promptly. This influences patient access to care by eliminating treatment delays due to processing or billing issues.
Forcura Is Your Solution For Optimizing Revenue Cycle Management
Forcura, a healthcare workflow management company, enables healthcare providers to streamline incoming patient information and coordinate ongoing patient care resulting in improved business performance.
Forcura’s solution provides transparency into clinical records and workflows so users can take follow-up actions accordingly. Analytical data can also be used to optimize processes and uncover new efficiencies throughout the revenue cycle. More efficient processes allow final collections on outstanding accounts to begin sooner and yield more profitable results.
Check out Forcura today to see how your care teams can meet revenue cycle management requirements promptly and receive the full payments they deserve.
