A revenue cycle management is a collection of steps undertaken to identify, collect, and manage revenue from the point of sale of the underlying services. Good RCM Practices are needed to run a health care system smoothly and maintain financial resources most effectively and efficiently.
A solid and well-established revenue cycle management is needed in Healthcare systems. Proper billing of the appointment and prescriptions are made to prevent financial losses and debts to the Health Care provider. The healthy practice of RCM enables the organization to focus on the core operations in channelizing finances in a single steam line.
Revenue Cycle Management Challenges
1. Casualties on billing– there are chances of missing some steps from the entire process of the movement the patient gets in appointment till the final payment. Sometimes, there could be omissions of recordings, cutting bills, misspellings of the patients’ names, Technical issues, duplication of the information, etc. All or anyone may pose the problem of mismatching the final balance sheet at the time of tally.
2. Changes in the regulations and reimbursement methods- It becomes tough to get timely reimbursement from the patient if some unfavorable rules and reimbursement models are introduced to collect repayment.
3. Inefficient administrative- The Healthcare provider may not have the right
amount and logistic, technological, and organizational sources to keep a good record of its staff and the patients with safety and security. So, they should focus on an efficient revenue cycle management (RCM) system to cater to the needs of the patient on time and manage the staff with precision.
Factors That Can Affect Revenue Cycle Management
1. Collecting patient payments – A Systematized RCM helps the administration of the medical care provider to manage the payments from the patients efficiently and effectively.
2. Fragmented Administrative Processes – There should be a synchronization between the front and back administration for better payer coordination, claims reimbursement, and hurdle-free payment collections from the patients.
3. Eligibility Issues – Administration should get the coats and related information regarding the claim reimbursement from the insurance company to minimize denial of the claim, delay in repayment, and non-tractable transactions.
4. Lack of Digital Workflow – Installation of required software and well-established IT infrastructure can bring tremendous change in managing the administration security and privacy to the data of the patient and the staff. Even the paperwork and documentation minimize and invest the spared time on planning and more critical tasks.
5. Invest in administrative staff – Effective revenue cycle management system emphasizes training in educating the administrative staff. The chief motive behind the exercises is to bring Efficiency in billing forms, coding, chart documentation, revenue cycle software operations, and insurance verifications.
Benefits of Revenue Cycle Management System
1. Time-Saving- Automation of duties like self-billing, collecting the payment, automatically maintained data, reminders for payments in reimbursements save a massive amount of time for the staff.
2. RCM helps in developing proper reimbursement mechanisms for the patients.
3. RCM aids in figuring out the insurance status and requirements of the patient.
4. RCM quickly finds out revenue shortfalls and misuses through software.
All medical-care providers should have a well-established revenue cycle management to prevent the shortfalls in reimbursement claiming and probabilities of misleading billings.