RCM is a financial process healthcare facilities use to monitor patient care stages from registration/ appointment scheduling to payment using medical billing software. It ascertains that healthcare providers get payment for their services. Revenue cycle management unifies healthcare’s business and clinical sides by integrating administrative data, like insurance provider and patient name, with the treatments patients are getting and their healthcare information.
With proper RCM, healthcare providers can optimize claim reimbursements while raising patient service proceeds. This post outlines five benefits of revenue cycle management in healthcare.
1. Addresses coding issues
Error-free coding is essential for prompt claim acceptance by insurers. Revenue Cycle Management stresses the significance of accurate coding practices to avert claim denials and the ensuing reimbursement delays. This involves allocating correct procedure codes and diagnosis depending on the provided services. For example, suppose a healthcare provider erroneously has a wrong code or doesn’t document each relevant procedure. This may result in underpayment or claim rejection.
RCM utilizes technology-based coding systems, coding staff ongoing education, and coding audits to ascertain accurate, docile coding practices. It implements automated coding systems and conducts coding reviews frequently to minimize coding errors. This lowers the risk of claim denials while optimizing reimbursement. Revenue cycle management uses industry resources and coding guidelines to ascertain precise code selection.
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2. Averts healthcare fraud
Healthcare fraud leads to losses amounting to tens of billions of dollars yearly. Fraud analysis can negatively impact healthcare facilities’ revenue and reputation. Revenue cycle management helps avoid fraud. Erroneous medical coding can result in fraud inspections. Billing for unnecessary procedures and services never offered are common concerns that can lead to fraud. It may also be due to poor-quality tests/ procedures and services conducted by unqualified or poorly supervised staff.
Procedure upcoding can also cause fraud assessments. RCM stresses on precise data collection, coding, and billing, reducing the risk of providers submitting inaccurate data to insurers. It also keeps insurance providers updated with the constantly-changing healthcare laws to ensure unintentional fraud isn’t an issue.
3. Streamlines processes and saves time
Revenue cycle management implementation enables healthcare providers to experience less administrative burden, saving employees’ time. RCM best practices help streamline and improve processes, enhance operational inefficiencies, and reduce time spent on appointment scheduling, payment processing, claim denials, and patient intake. This promotes effective time allocation with a major focus on delivering quality patient care plus other crucial responsibilities.
4. More claims paid after first submissions
Effective RCM intensifies focus on correctly completing front-line tasks to ascertain that claims are paid after initial submissions. While most insurance denials occur due to technical issues and human error, they can be prevented. Revenue cycle management prioritizes claim accuracy before submission to avoid costly delays and ensure claims are reimbursed immediately.
5. Improves patient satisfaction and experience
Optimizing revenue cycle management simplifies healthcare-related processes, like billing and scheduling, to improve patient engagement and boost satisfaction, leading to better patient outcomes. Effective RCM translates to improved patient experiences. It ensures patients get more targeted, robust care, lowering re-admittance possibilities. The upfront insurance verification that comes with RCM enables patients to know more about their insurance qualifications. This ensures out-of-pocket expenses don’t catch them off-guard.
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RCM can be quite rewarding for the healthcare industry. Consider implementing revenue cycle management in your healthcare practice to reap these benefits.