The medical billing revenue cycle management is defined as all that is to be done involving the monetary steps in healthcare, from when the patient first makes an appointment to when the last penny has cleared. It includes patient insurance verification, obtaining preauthorizations for certain treatments, proper code of medical services claims transmission to insurance companies, and managing payments or addressing any claim denial. Connect with us, as we’ll discuss RCM, its benefits, and steps to improve it and gain more space in the marketplace. Stay with us till the end of this blog!
What Is Revenue Cycle Management?
Revenue cycle management is a method that healthcare organizations follow to manage money concerns related to billing and collection of payments for services rendered in medical facilities. This process starts when a patient makes an appointment and ends when the account balance is paid off. RCM is very important for boosting revenue.
Moreover, it does this by reducing claim denials and lowering the number of days money is tied up in accounts receivable. Although the main aim is to improve collections, providers also benefit because they get accurate and timely payments. Maximize your revenue with precise, accurate, and error-free billing and coding services. Reach out to us at MAVA Care and schedule a free consultation today!
What Is the RCM Process?
The RCM process involves payment for healthcare organizations to pay mental health experts for their services. These services might include medical billing, coding, credentialing, AR follow-up, and front desk management. The revenue cycle process in healthcare is important, and it involves patient registration, insurance verification, and claim submission. Although it may seem complex, this process is essential because it ensures that providers are compensated for their work.
After that, payment posting and accounts receivable management happen. This process includes tracking claims, managing denials, and ensuring accurate medical coding because it helps secure timely reimbursements. However, efficient healthcare revenue cycle management ensures smooth financial operations, reducing errors. Although it can be complicated, improving cash flow for healthcare providers is crucial. Thus, a medical Billing company can enhance its financial performance by applying accurate and timely claim submissions.
How To Improve Revenue Cycle Management?
There are many ways to break down the steps of revenue cycle management. These steps are important because they help ensure everything runs smoothly.
Step 1: Pre-Registration
Pre-registration refers to software that allows you to collect a patient’s information before the patient makes an appointment. By gathering their insurance and billing information beforehand, you may estimate how much the patient will owe for the planned services.
Data to collect during this step:
- Patient name
- Patient demographic information
- Medical history of a patient
- Season of patient visit
- Insurance information
- Billing information
Step 2: Registration
This will have been done in-house when the patient comes in for an appointment, or it may have been completed online by the patient. At this stage, you may be able to ask them to confirm their medical history and complete any forms necessary. When registering a patient in the period they are coming into your business, you can check the following:
- Address
- Date of Birth
- Insurance coverage
- Phone Number
- Identification
- Phone Number
Step 3: Insurance Verification
The patient’s insurance company or health plan does this step if needed. Here, they check the medical need for the planned services. The insurance provider will decide if it will pay for these services for this patient. This choice can take a while, but knowing that the provider will send the info back to you is important. Although it can be annoying, you must wait for their answer.
Step 4: Payment Posting
Payment posting is entering payments from insurance companies into a patient’s account in the medical billing system. This step is important to ensure an accurate reflection of the payment. However, it allows for proper adjustments of patient balances. It also helps identify denials or partial payments, which can be tricky.
Step 5: Medical Billing
Medical billing involves charging patients for any balance remaining after the insurance has processed a claim. It can include copayments, deductibles, or charges for non-covered services. It’s crucial to ensure patients receive clear and detailed statements outlining these balances to understand what they owe. Timely patient billing helps maintain cash flow and reduces the risk of accounts becoming overdue.
Step 6: Medical Coding
Once the insurance provider accepts coverage and the procedure has taken place, the procedure must be coded into billable charges. Each procedure is assigned a billing code, and the coders learn how to translate documented procedures from the patient’s treatment record into those billable codes. The resulting codes are then utilized to formulate claims for payment and bills to the patient.
Step 7: Claim Submission
Following the transmission and encoding of the claim, these claims are then forwarded to the patient’s insurance company. The payor would scrutinize the claim and look for mistakes or inconsistencies in the claim and procedures that have already been approved. Such a process is tedious because it entails scrutinizing minute details.
Step 8: Insurance Follow-up
You have collected payment from the payor at this point in the medical revenue cycle. However, during this step, you might face issues like nonpayment for claims, denials for claims, and under or over-payment of claims. Although this can complicate things, staying on top of these problems is important because they can affect your overall revenue.
Step 9: Denial Management
Denial management prevents, investigates, and resolves denied insurance claims. Physicians lose a lot of money every year because of denied healthcare claims. These claims could have been avoided with better denial management processes. However, it can be difficult to implement these processes effectively.
Step 10: Collections
Once you have collected from the payor, you need to determine how much is left over on the account and make any determination of any remaining patient responsibility. This will be one of the most difficult steps for some organizations. Make sure you immediately send out statements; the sooner you send the statement, the sooner you have a chance to receive payment.
Revenue Cycle Management in Medical Billing
The healthcare revenue management cycle refers to the systematic management of financial processes within healthcare service delivery. It is, therefore, a series of steps starting from the initial patient encounter to the final payment of a balance.
The medical revenue cycle management process spans patient registration, insurance verification, coding, billing, submission of claims, posting of payments, denial management, and collections with the patients. It aims to optimize the financial performance of medical practices through reduced claims denials and faster payment cycles with good cash flow.
Revenue Cycle Management in Healthcare
As a healthcare process, medical billing revenue cycle management refers to the business process allowing organizations to get paid for service delivery. There are 17 distinct steps in the revenue cycle, from patient scheduling to payment reconciliation. Revenue cycle management for health care is effective and ensures that the whole process, from a patient’s initial inquiry to final payment, goes well. That means proper information is collected and recorded, patients are billed for only services rendered, third-party payers are contacted early, and payments are collected.
Revenue Cycle Management Benefits
Healthcare businesses rely on RCM revenue cycle management services for financial stability, efficiency, and better patient care. Some of the benefits that customers derive from these services include:
- Financial Security: RCM ensures a predictable stream of funds to healthcare providers by capturing and collecting payments for services rendered on time.
- Efficiency and Costs: RCM conserves time and resources consumed by administrative tasks such as billing and coding, freeing the personnel to spend more time with the patients.
- Better Patient Experience: An efficiently implemented RCM system ensures that the billing and payment processes are much easier and not confusing for people in patient care.
- Revenue Performance Enhancement: This is perhaps the most important benefit of a well-run RCM. Hence, payments will begin to arrive more promptly, steadily, and with fewer out-of-pocket costs. In short, the main purpose of medical billing revenue cycle management is to enhance your financial performance.
- Process Improvement: Ensure doctors, administrative staff, coders, or whoever touches the revenue cycle can now access a safe and easy solution. Good RCM reduces mistakes and unclogs the ports of confusion and frustration from your staff.
- Revenue Performance Improvement: Revenue performance improvement is probably the most significant offered by an effective RCM program. Therefore, payments will come in more swiftly, smoothly, and with fewer out-of-pocket costs. Briefly, RCM primarily focuses on improving your financial performance.
Challenges In Revenue Cycle Management
1. Evolving Healthcare Regulations
The healthcare regulations are dynamic; they keep changing, touching different aspects of RCM, including its billing practices, patient data privacy, and data security. So, the providers must be very careful about the dynamic changes around them.
2. Difficulty in Coding and Billing
The healthcare industry has very complicated billing and coding; thousands of codes for diagnoses and procedures are constantly being revised. One needs to continually learn and adapt regarding proper coding practices to stay abreast of changes.
3. Growing Patient Responsibility
More patients would have to incur greater shares of their healthcare costs personally since they are using high-deductible plans. Generally, it is harder to collect payments from the patient than from the payers since patients possess fewer resources and capacity than the insured.
4. Staff Training and Turnover
There is a need for continuous employee training because billing practices, coding, and regulations are always in a state of change. High turnaround rates in RCM roles can allow for inconsistencies in processing when the revenue cycle is disrupted.
5. Data Analysis Burden
Handling bulk data collection, integration, and interpretation might be cumbersome. This makes it difficult for organizations to effectively use it in making decisions.
Revenue Cycle Management Solutions
Revenue cycle management solutions help businesses make the most of their revenue streams by ensuring the smooth and accurate execution of business processes. These solutions automate and enhance customer acquisition, billing, order tracking, collections, returns and refunds, tax compliance, and more. Besides analytics-driven data, revenue management solutions improve informed decision-making by providing greater visibility into a company’s financial operations.
Such solutions can automatically limit the physical labor and potential errors brought in through manual data entry. It will increase the chances of accurate financial data and make sales processes more efficient. Data collection can help the business understand existing revenue opportunities or the points at which improvement points exist. Automated processes, like recurring billing, can save time that would be exhausted invoicing clients and ensure timely payments. Get the best solutions for medical billing, coding, credentialing, and AR follow-up with MAVA Care! Just give us a call or email us at info@mavacare.com and we’ll handle the rest.
Medical Billing Services in Texas by MAVA Care
MAVA Care offers complete medical billing services in Texas that boost revenue cycle management for healthcare providers. Our services include precise claim submission, timely accounts receivable follow-up, and effective denial management to ensure maximum reimbursement. We employ skilled medical coding professionals. However, we also focus on compliance and accuracy in billing.
Ongoing medical credentialing services are provided to enhance provider qualifications, although some might overlook this. With a focus on efficiency and transparency, MAVA Care aims to reduce billing errors and accelerate cash flow. We want to improve overall financial performance for healthcare practices across Texas because this is crucial in the industry.
Concluding Note
The main goal of medical billing revenue cycle management is to increase and make sure revenue is accurate throughout the different steps of the cycle. This is done by finding problems and then fixing or getting rid of those problems. Medical Billing in RCM helps a medical facility work better to meet rules for improved cash flow. There should be analytics-driven billing metrics to create faster payment solutions for providers using automated workflows. To achieve the best revenue cycle management and a low denial rate with accurate claim submissions, you can rely on MAVA Care medical billing company. Book a free demo today! Although the process can be complex, that is worth a lot. Thus, some challenges may arise because the system needs to be properly set up.
