Though healthcare systems have a mandate of saving lives, they need to develop processes for staying profitable. This is where healthcare revenue cycle management comes in. Revenue cycle management is the processes facilities use to manage claims processing, revenue generation, and payments. Essentially, it involves the collection, identification, and management of revenue. Without revenue cycle management, organizations cannot maintain their facilities and treat patients. It is what they do to pay the bills.

The Basics of Healthcare Revenue Cycle Management

When a patient requires services, the administrative staff must handle the insurance eligibility, account establishment, and other patient registration concerns. This step is necessary for optimizing the entire cycle because staff need to account for medical history, insurance coverage, and the like.

It’s vital to get the most accurate information, and this process starts with patient registration. These tasks provide the groundwork for billing and collecting claims properly—you don’t want a claim submission that gets shuttled to and from offices because of errors.

Afterward, the healthcare provider must create a claim submission and identify the nature of treatment and the ICD-10 code. This code signifies the amount by which an entity gets reimbursed for specific treatments. Coders need to do this step carefully to avoid claims denials. Providers also complete charge capture duties. This step allows them to convert services into billable fees.

The next step in revenue cycle management is sending the claim to a payer for reimbursement. The healthcare company must still oversee back-end tasks like payment posting, collections, statement processing, and more. When the payer evaluates the claim, they pay the organization for services depending on the patient’s coverage.

Implementing Cycle Management for Healthcare Organizations

Most management strategies focus on front-end tasks since these are where most errors occur. Providers must verify a patient’s insurance eligibility so companies can reimburse the medical organization for the services it provided. This step is crucial, especially for uninsured patients, since it helps determine their Medicaid eligibility and understand their options.

An organization also needs to manage claim denials efficiently, which requires developing procedures for resolving claims issues. There are various types of issues that can crop up, like improper ICD-10 coding, missing signatures, and the like.

Furthermore, the staff needs training on completing tasks like using billing forms, talking to patients regarding medical costs, and investing in revenue cycle management infrastructure. They must also know how to track claims and identify sources of denials regularly.

Using Technology in Facilitating Revenue Cycle Management

Since organizations apply a value-based care model, they emphasize quality care, patient satisfaction, health IT use, and lower healthcare costs. Analytics helps organizations manage these large volumes of information. Big data analytics allows healthcare systems to predict claim results and inform employees of revenue goals.

For instance, there are RCM tools specifically for the ambulance industry. These tools are specifically for the ambulance industry, and they help ambulance companies focus on key performance indicators allowing them to remain in the black.

Since ambulance companies deal directly with saving lives, the priority is first aid and getting the person to the hospital safely. As such, collection processes become an afterthought. With the help of revenue cycle management services, ambulance companies can get help resolving revenue issues. Their healthcare RCM service can also analyze, monitor, and improve billing and collections properly.

Efficient Revenue Cycle Management for Your Healthcare System

Like other organizations with expenses, healthcare systems need a healthy cash flow to succeed in healthcare revenue cycle management.

Empower your healthcare organization’s technological transformation with Credence Global Solutions. We provide revenue cycle management solutions for medical transport services, from patient in-take to post write-off services. We also offer solutions for medical groups, physician staffing, and diagnostic laboratories. Get in touch with us today!