When a patient schedules an appointment to receive medical services, the healthcare revenue cycle management process begins. Once all claims and patient payments have been received by the organizations, the procedure is complete. Administrative personnel must first handle scheduling, confirming insurance eligibility, and creating patient accounts when a patient makes an appointment.
The key to streamlining revenue cycle management procedures is patient profile creation. During this phase, staff members build a patient account that contains information on medical histories and insurance coverages. The ability of revenue cycle management to pull the insurance information, confirm accurate patient information, and collect the patient’s financial obligation decrease rework across the revenue cycle and, in turn, reduce possible claim denials.
The Revenue Cycle
The healthcare provider must generate the submission of a claim and finish charge capture tasks following a patient visit. The patient’s health plan will pay the entity a certain amount of reimbursement based on the code that the physician or coder selects for the service. By choosing the best code for the services, you might avoid having your claim denied. The services are converted into billable costs through the charge capture procedure.
The practice submits a claim to a private or public payer for payment after creating it. For healthcare systems, revenue cycle management does not stop there. The management of back-end administrative duties such as payment posting, statement processing, payment collections, and claim rejections that are connected to claims reimbursements are still required.
The healthcare provider must generate the submission of a claim and finish charge capture tasks following a patient visit. Depending on the patient’s coverage and payer agreements, healthcare organizations often receive compensation for their services after an insurance company examines the claim. Claims can occasionally be rejected for several reasons, including incorrect coding, items missing from the medical file, or insufficient patient accounts.
Outsourcing a Healthcare’s Revenue Cycle Management
The goal of healthcare revenue cycle management services is to create a procedure that enables businesses to swiftly get full payment for their services.
However, the processing of invoices, claims verification, and claims in revenue cycle management typically take a while. Claim disputes sometimes go on for months as payers and providers exchange information back and forth. The payer will either approve the claim and pay the provider at the remittance processing stage or refuse the claim.
Since patients sometimes lack the money to pay medical bills right away, revenue cycle management may also be a drawn-out process. Your outsourcing RCM partner may guarantee prompt refunds by staffing 24-hour billing representatives.
How does Professional Revenue Cycle Management Help Accounting Function?
Here are a few ways in which you can improve your accounting functions with efficient revenue cycle management.
Fewer Cash Flow Interruptions:
Medical billing outsourcing companies have the necessary software and infrastructure to handle billing. Medical billing is completed when the practice provides the necessary paperwork, and all other processes like insurance verifications and AR collections are followed up within a day or two. Thus, cash flow is enhanced. The absence of administrative duties allows doctors to concentrate on learning-enhancing activities like attending seminars.
Errors in billing are less common:
An outsourcing RCM company completes insurance eligibility verification and would never make common billing mistakes like inputting the erroneous patient name or CPT codes thanks to the availability of experienced employees and technology. The reputation of a healthcare institution might be enhanced through error-free invoicing.
Maintaining Regulatory Compliance:
Staff may not have enough time to keep up with regulatory changes and compliance difficulties if billing is done internally. An outsourcing RCM partner will introduce administrative processes to ensure compliance operations. A healthcare institution won’t have to stress about industry rules, payer guidelines, or compliance
Expertise in billing and coding from a professional source aids in reimbursement optimization. The right code and regulations may be applied by an RCM outsourcing company, producing better reimbursements.
Think of a scenario in which a member of your team takes a vacation and the RCM function is impacted by the need to delay the processing of claims until they return. Indirect cash flow and timely reimbursements will be impacted by billing interruptions.
Increased Efficiency and Profitability:
Due to the outsourcing of RCM services, medical professionals now have plenty of time to concentrate on enhancing clinical efficacy. The medical practice’s income is significantly increased when these difficulties are handled by a committed revenue management team.
Account Receivables (A/R):
A strong RCM partner assists healthcare practices in monitoring insurance company AR reconciliations. Follow-ups on accounts receivable are crucial and aid healthcare service providers in concentrating on patient care. Payments will be processed more efficiently if you outsource to an RCM partner that has a skilled group of A/R specialists who have experience working with multiple insurance companies and are familiar with the policy.
Owning and running your RCM operations may be expensive; it calls for devoted staff that gets continual training and supervision. You may save costs and time connected with internal operations by shifting this overhead to an outsourced RCM company, which will increase profitability.
Lower capital costs:
It takes infrastructure investments, resources, technology, and investment to maintain an internal RCM system. You may concentrate on operational expenses rather than capital investments when you outsource RCM. This, therefore, increases your revenue control, scalability, and tractability.
Flatworld Solutions have a streamlined approach to revenue cycle management in healthcare. the depth of services offered can help the practices to ensure proper attention towards patient care, leaving the ancillary functions to Flatworld. Revenue cycle management through professional services like Flatworld Solutions helps greatly in easing the accounting functions as well through the above-mentioned points.