Healthcare Revenue Cycle Management – A Detailed Study

When somebody is sick and is admitted to the hospital, it is the responsibility of the doctors, nurses, and other healthcare professionals to take care of and cure the patient. Therefore, besides considering the patient’s health condition, every healthcare organization should also focus on financial policies and development. This is where healthcare revenue cycle management comes to aid.

What is healthcare revenue cycle management?

When a patient is admitted to the hospital, somebody is keeping a watch on the financial aspect. Now, almost every hospital has a study medical billing software to generate the regular billing amount efficiently. This software helps the hospital staff to handle a lot of monetary work efficiently within less time. Also, this software creates the facility of taking care of the health insurance of patients.

All these financial dealings together are known as healthcare revenue cycle management. Belonging to the category of health information management, healthcare revenue cycle management also takes care of electronic health records and follows methodologies that maintain patients’ privacy. To operate a healthcare unit professionally and successfully, one has to ensure that the billing process is handled accurately and correctly.

Benefits of healthcare revenue cycle management

Want to know the reasons behind engaging in and practicing healthcare revenue cycle management? Here they are:

1. Complete optimization of workflow to generate more cash

Optimizing the whole process means enhancing the efficiency of the system. This implies that payments can be made mode simply by using the revenue cycle management. Other benefits include reduced errors and improvement in cash flow. To state an example here, if a healthcare organization uses an electronic health record system, the task can be simplified and improved by promoting better scheduling, billing, coding, and carrying out error-free payment processes.

2. Helps to reduce the workload

If a machine is oiled well, it is sure to run smoothly without getting stuck anywhere. The same rule applies to the healthcare units. With the revenue cycle management, one can be sure of gathering collections at ease. It makes the organization financially stable and reduces the burden from the people associated with the administrative level of the organization. Everything is made possible with the revenue cycle management, from coordinating communications with the hospital professionals and the patient party to maintaining important documents and dispatching payments at the right time.

3. Better patient experience

Having a skilled and efficient revenue cycle management will yield an error-free coding process and effective billing. The whole process is simplified and made better so that the patients do not feel any hindrance or difficulty in their entire journey. Suppose a healthcare organization wants to deliver the utmost satisfaction to the patients. In that case, it has to keep the patients away from unnecessary problems that can induce stress in them.

4. Handles payment denials efficiently

Payment denials emerge from errors in the bills or the payment claims. A customized and optimized healthcare revenue cycle management means generating accuracy in the system and controlling the number of mistakes that could have been made otherwise. Therefore, it is essential to get the coding right at the first chance to save time and bring in faster payments.

5. Improved revenue collection process

Combining automation tools with the right software means all those tasks that would otherwise take a lot of time to complete will now be accomplished with less time. Furthermore, if the entire process is executed in a stepwise manner, there will be no problem while expediting.

Steps involved in healthcare revenue cycle management

The healthcare revenue cycle management is a seven-step process as discussed below:

Step 1: Preregistration

The medical practitioner has to gather demographic information, eligibility, and insurance details in the first step. Next, the insurance agent gets the patient’s information and discusses the insurance coverage with the medical professional. In this preregistration stage, the practitioner can understand the patient’s financial expectations from the insurance. He can also get clear the doubts of the patient regarding payment.

Step 2: Registration

In the registration process, the information gathered about the patient is 100% true and accurate. Therefore, while conducting the registration process of a patient, the professional has to ensure that the correct name, address, phone number, date of birth, and valid proofs are provided. In addition, during this registration process, the professional has to gather the co-payments or referrals with authorization for further patient treatment.

Step 3: Charge capture

The charge capture can be carried out in multiple ways. If the process is automated, all the information will be automatically carried forward to the billing section. On the other hand, the charge capture can also be done manually. If there are loopholes in this process, they will be detected by a revenue cycle auditor. So, it is vital to make sure that charges are being captured correctly.

Step 4: Claim submission

After the charges are entered, they have to be forwarded to the insurance agent. The people responsible for the revenue cycle management will have to pay attention to the expenses, diagnosis, and CPT codes. It has to be ensured that the claims are clean being handled correctly.

Step 5: Remittance processing

After the claim has been passed, the medical professional will get back remittances. It is during this step of the healthcare revenue cycle management that the allowance are determined. Here, the provider and the insurance agent will decide to negotiate and determine the amount they want to pay.

Step 6: Insurance follow-up

This is a routine follow-up process where the professional medical provider checks out those paid and those still left to be paid.

Step 7: Patient collections

It is suggested that the front desk professionals take the money from the patient when they are served. To avoid any commotion, ensure that the provider has adequate documents to prove that the charges have been rightly taken.

Conclusion

After knowing the benefits of revenue cycle management, it can be said that revenue cycle management for the healthcare industry is an apt solution to generate more cash flow. Furthermore, for better services, one can hire revenue cycle management professionals.