Important steps involved in the healthcare revenue management cycle

Healthcare service providers strive to provide excellent services to patients. In fact, they want to be better than competitors in all aspects. However, this sense of competition makes sense only when the healthcare provider has managed their financials well. To get a better grip on the income and reimbursement procedures, it is important to learn about the hospital revenue cycle. 

Steps for Healthcare Revenue Cycle Management

The most important steps in healthcare revenue cycle management can be outlined as under:

  • Outsourcing processing or RCM Software installation

Is your organization so big that its revenue cycle management can be tedious to handle? If this is the case, the hospitals have a dedicated wing taking care of revenue management issues. The smaller organization can consider installing RCM software to give revenue cycle managing a head start. 

Sometimes, even if the organization is small, the owners may not be so trained in revenue management issues. After all, their core expertise lies in providing treatments to the patients and not in managing the paperwork. Thus, outsourcing comes as a sensible option for hospitals and other healthcare service providers when it comes to managing the revenue cycle.

  • Pre-authorization of patient

The US Govt makes it mandatory for every treatment to be accompanied by a prescription from a registered medical practitioner. The prescription entails the kind of equipment, medicine and healthcare that will be required for the treatment of the patient. Revenue cycle managers can approve skipping of a patient’s pre-authorization when there is a case of a medical emergency. However, during the course of medical treatment, the healthcare providers can try to find the medical insurance enabling procedures of such patients by referring to their PECOS certification records.

  • Verification of patient’s eligibility for benefits

Modern RCM software makes it easy for the medical billing company to find the patient’s eligibility for any kind of benefit. It is a common fact that patients are either accompanied by the attendants who are not much aware of the patients’ benefits. Sometimes, patients are all alone and not able to tell anything about the same by themselves. In such cases, the RCM software scans the patient profile, tells about his insurance policies and finds if their case is entitled to get any kind of benefit under the possible heads.

  • Claims submission

When entertaining the cashless insurance claims, the hospitals have to be thorough and quick to submit the claims. Their spending of resources on the treatment of patients can come down heavily on them when the staff handling RCM is not aware of the procedures. It can increase their receivables head which, ultimately, may put the pressure of liabilities on the hospital or healthcare organization.

Therefore, claims submission is a very important step in the revenue cycle management process of any healthcare providing service.

  • Posting payment received

The next step in revenue cycle management of a hospital is posting of payments received against the claims submitted to the insurance company. This posting of payment means that the payment is now clear from the patient’s side. In case the patient is having post-payment reimbursement, the system prompts the patient to make payment when the claims’ correctness has been ascertained by the insurance company.

  • Denial management

It becomes a matter of grave concern when the claims are being denied in high numbers. The poor reimbursement rate can cost the healthcare organizations heavily and may put it under financial stress. 

The biggest cause of denial management is an incorrect submission of claims. The patients may have filled the claims form incorrectly, or there can be some human error on the part of the claims receiver. Too many people working together on any claims case also become a big source of error. This raises the importance of efficient denial management. Largely, it is the guidance and revisiting of rules work that is done to keep denials within the limit.

  • Reporting

The final step in the functioning of an RCM is reporting.  The software tells about the claims submitted, denials and claims disbursed in a report form which can make it easy for the accounts department to understand the situation and make decisions.

Thus, RCM proves to be an effective tool and is designed in a sequence of steps that make it easy for healthcare providers to function efficiently and survive the challenges of the healthcare market.