Want to Run RCM Operations Efficiently? Check out these Best Practices

What is Revenue Cycle Management?

Healthcare professionals train for years to treat patients and save lives while learning next to nothing about the business side of practices. Providers need to develop successful practice management processes to stay financially healthy. A medical facility’s entire financial process is termed Healthcare Revenue Cycle Management (RCM) and it covers the management and collection of revenue from healthcare services to patients.

The healthcare revenue cycle starts when a patient makes his/her appointment to seek medical services from a healthcare provider. The process ends when claims are reimbursed and patient payments have been collected. 

The Front Office and its Importance

The first step in the RCM is to carry out the insurance eligibility verification of the patient. Demographics entry is also made at this stage. These two steps are crucial, for mistakes made at this stage are carried forward to the end resulting in claims rejection. The billing team uses various sources to ensure that eligibility verification is done thoroughly and accurately.

Back-office Workflow

Once the patient visit is over, claims preparation and submission processes have to start. The diagnosis and treatments carried out must now be codified. in particular, the correct codes must be identified to describe best the diagnosis/treatment. Incorrect coding will result in claims rejections. Hence certified coders should do the coding accurately. Further, they must be trained regularly and their knowledge kept up to date regarding the many changes being made by medical authorities and payors.

Charge entry is the next step when the amount to be reimbursed by the payor is determined. Billers should have the expertise to arrive at the right amount to be billed.

Next, the claim is electronically submitted to the concerned payor for reimbursement. The reimbursement is done based on patient coverage and payor contracts. And claims can be rejected based on various factors. Therefore workflow processes should be designed to ensure that there are minimum rejections.

It is important that for procedures/treatments not covered by insurance, the amount must be collected from the patient, preferably at the time of the visit.

The later phases of back-office processes

The other phases that follow are payment posting, patient statements, reporting and denials management. Denial management is a process needing a well-thought-out strategy.

Astute use of technology for RCM processes and communication will lead to faster processes and a narrower margin for errors. Further, staff should be trained in multiple EHRs, so clients need not worry about integration.

How Bristol Healthcare can help you

At Bristol Healthcare Services, every stage of the RCM is of equal importance. We work patiently and diligently to submit/resubmit correct claims and obtain payment for your services. Our processes are transparent and you have complete knowledge of the work being done for you. The company’s system of reporting to you will keep you updated on the status of your claims.

The goal of RCM is to design processes that help healthcare providers get paid the entire amount for services rendered in the quickest possible time to keep the cash flow uninterrupted. Bristol Healthcare Services has been doing precisely this for the past two decades.

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