Errors To Avoid In The Steps Of Healthcare Revenue Cycle Management

Revenue cycle management is a word that describes the process of maintaining a healthcare organization's financial health.  

An efficient revenue cycle management method is essential in the healthcare business. Administrative and clinical data, such as a patient's name, insurance provider, and other personal information, are combined with the treatment and healthcare data they receive in Revenue Cycle Management. One of the most important aspects of RCM is communication with health insurance companies. Let us define revenue cycle management and how it works before we go any further. 

This is a universal PPP procedure in which the payer pays the provider for the patient's services. From registration to appointment scheduling to final payment of a balance, medical billing software is used by healthcare firms to track patient care activities. The revenue cycle management process is composed of seven steps, which are,  

1. Preregistration, 
2. Registration, 
3. Charge capture, 
4. Claim filing, 
5. Payment processing, 
6. Insurance follow-up, and  
7. Patient collections. 

This article goes over each of these processes, what they include, and what might go wrong during the revenue cycle. Let us describe it to you in more detail, 

1. PREREGISTRATION: 

The revenue cycle process begins with preregistration, which is the most key step. It enables medical practice to customers, insurance, and eligibility information in real-time. Many things can be neglected if a provider lacks a detailed preregistration process. 

2. REGISTRATION: 

The procedure of verifying that the patient's information is 100 percent accurate is formalized through registration. Financial paperwork is signed and insurance benefits are assigned during registration. There is a possibility of financial consequences if these steps are skipped and the practice is audited. 

3. CHARGE CAPTURE: 

The third step in the revenue cycle is charge capture. It can be automated or done by front desk workers the old-fashioned way. An experienced advisor can assist you in locating missing charges and identifying charges that have been miscoded. 

4. CLAIM FILING: 

The procedure of filing claims ensures that they are accurate and enter the system correctly. If a claim is received in acceptable shape, it will be processed more quickly. As part of the procedure, claims are routed from your practice management system to a payment processor. 

5. PAYMENT PROCESSING: 

• Payment processing is the fifth step in the revenue cycle. Allowable is the amount agreed upon by the provider and the insurance carrier for a service rendered.  
• Fee schedules, which are the amounts providers charge for each service, are another component of remittances.  
• No authorization, no reference on file, and claims not presented promptly are all red flags. 

6. INSURANCE FOLLOW-UP: 

The accounts receivable (A/R) report displays anything that has been sitting in the insurance and/or patient buckets for some time. This report will reveal whether insurance follow-up is ineffective and why it is taking so long to receive payment. 

7. PATIENT COLLECTIONS: 

• The best moment to collect money from a patient is when they are at your office. 
• Front-desk personnel should be trained to collect now of service.  
• Examine your company and deductible policies to see if you have a typical procedure in place. It is equally important to send out routine patient statements. 
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BENEFITS OF REVENUE CYCLE MANAGEMENT: 

Revenue cycle management, or RCM, is used by healthcare providers to ensure that they are compensated correctly and on time for their services. This is beneficial for both the physician and the patient. These benefits include: 

1. After the first submission, the average percentage of claims paid increased. 
2. Current claim percentages have increased on average (0-60 Days). 
3. The denial rate is down. 
4. The practice's net income has increased. 
5. A higher proportion of claims are free of errors. 
6. Accounts receivable have been reduced. 
7. Claim payment is processed more quickly. 
8. Fewer claims have been made. 
9. More time for patient care issues, resulting in higher quality of care. 
10. Patient information that is correct is available, and your team is less stressed. 

COMMON BLUNDERS OF RCM IN HEALTH: 

Avoiding mistakes and rejections is the greatest practice. If your organization does any of these revenue cycle management blunders, you are undoubtedly losing money. Providers make several frequent revenue cycle management blunders. 

• Failure to meet the needs of the payers.  
• Reading your insurer's newsletter is not enough. 
• Failure to maintain track of the claims process from beginning to end. 
• Claims that have been rejected are not resubmitted. 
• There was no verification of the patient's eligibility. 
• Trends are not being collected. 

 CONCLUSION: 

Healthcare revenue cycle management is changing to keep up with rapid changes in the healthcare environment, including value-based treatment, innovative technology development, and a global pandemic. Healthcare practitioners should always be aware of their revenue cycle status to give appropriate treatment to patients and get proper compensation for services. 

So, if you want to boost your office's revenue, stay connected with MHRCM.