Revenue Cycle Management (RCM) refers to the process in which claims are processed, payments are received and revenue is managed. RCM has become such an integral part of the profitability and maintenance of health care providers across the country, and around the world. Without the ability to track claims throughout the entirety of the filing and payment process, medical facilities lose a substantial amount of potential income. A consistent revenue stream is important, particularly with the amount of funding cuts and increase in operation costs. With the proper technology to track and maintain billing integrity, healthcare providers can ensure that they stay afloat and continue to provide quality care to all individuals.
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Not All Systems are Equal
Most clinics and healthcare facilities will have a revenue cycle management system in place, but not all systems are built equal. Although the RCM in place may seem to be doing an adequate job of tracking and following up on claims, it is worth it to look further into ones RCM solutions. Only when one looks further into their existing management process can its efficacy be proven, and points of improvement can be found.
One of the first key areas to look at when evaluating ones Revenue Cycle Management system is how it is set up to handle claim submissions. Look at how quickly and frequently claims are updated, and whether any changes to the claims are specific to the payer. It is also worth it to see if the technology used is out-of-date; current tools allow for initial claim rejections within a matter of seconds. Older tools used for claim rejection in the front-end could take up to a couple of days, wasting precious resources and misleading claimants. It is imperative that initial claim rejections be found before any claim is submitted to the claimant; without this, denials will skyrocket and cash flow will be slowed.
Time Matters
Another key factor in a successful Revenue Cycle Management System is ensuring that client service is quick and effective. Any RCM support staff utilizing the existing system should be acting on claims and claim resolutions in a timely manner; any delays will also delay revenue streams. Ideally, the staff that deals with claims will be responsive, and have sufficient experience in dealing with clients both in person and on the phone. Staff with the proper experience in client service will be able to resolve any potential issues on the first interaction with a customer. With slow response time and lengthy problem solving, efficiency is lost and clients can become agitated and disenfranchised with the system.
Staying Connected
One aspect of Revenue Cycle Management that is sometimes overlooked is connectivity and it’s relation to electronic remittance. For primary claims in particular, staying connected to payers is imperative; look further into RCM solutions in place and see whether or not potential claimants can receive electronic remittance advice. Establishing a good track record is important to how quickly claims are paid and how confident payers are in the RCM process as a whole. This is why it is essential to choose the right provider for any and all RCM solutions and software.
For any medical practice, there are a myriad of elements that need to be taken into consideration in order to be profitable, but if the above factors are taken in turn and the Revenue Cycle Management solutions are proven wanting, it might be time to switch providers. Do not be afraid to delve deeper in to what solutions have been provided, and critique them for any gaps in efficiency and claim resolution time. Look for RCM providers and software that will satisfy the unique needs of one’s particular healthcare facility. One way to tell whether or not ones RCM is operating efficiently and properly is the response time and satisfaction of clients. With early denial tools, more clients will be granted access to claims, and the more efficient the process is, the more positive a reputation these claimants will proliferate among friends and colleagues.
When locating Revenue Cycle Management software, look for a company that has a good reputation among clinics, and provides easy user-interface with excellent customer service. Emerald Health offers all medical practices and facilities the opportunity to improve upon their existing RCM system or introduce software to an outdated system; physicians and clients alike will be thankful.
This article was written by Gil Molstad, who has been in the healthcare industry for several years and knows the machinations of the Revenue Cycle Management system.
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