Revenue cycle management is basically a financial process that health care facilities use, to track patient care episodes that are from appointment to registration and appointment scheduling to final payment of balance. It amalgamates the business and clinical sides of healthcare by interlinking administrative data such as insurance provider, patient’s name and other personal information and treatment that patients receives. This process manages and handles office claims processing, revenue generation, and payment. Revenue cycle management also includes things such as coding claims correctly, tracking claims and following up on denied claims and determining patient eligibility. This process is now used by different hospitals and healthcare centers to get software easily for payments in a timely manner. Let’s discuss few benefits of revenue cycle management.
Importance of Revenue Cycle Management
Revenue Cycle Management system help healthcare professionals by saving lot of their time. This system automatically performs all the duties and functions that were previously handled by employees. The duties and tasks basically include reminding payers and patients of an existing balance, informing patients of an upcoming appointment, and reaching out to insurers with specific questions when a claim is denied. It also helps in saving providers money by reducing the amount of denied claims and enabling patients to pay their bills online. Revenue Cycle Management system can easily cut down on rejected claims by encouraging all healthcare professional to enter all the information and data that are needed for claim processing and saving them revising and resubmitting the claims. With proper revenue cycle processes and workflows, you can also easily increase payments while decreasing bad debt write-offs. An efficacious revenue cycle system can even lessen the amount of time between providing a service and receiving payment for it by intermingling with other health IT systems such as electronic health record systems and billing systems.
Important Terms Used in Revenue Cycle Management
Charge Capture: Charge capture is a term used when documented services are electronically or manually translated into billable fees.
Claim Submission: When billable fees are submitted to the insurance company through universal claim form of payment, then it is called claim submission.
Coding :Coding refers to the process of transforming descriptions of medical procedures and diagnosis into universal medical code numbers.
Patient Collections : The patient collection is a method of collecting patient balances and making payment arrangements.
Pre-registration :Pre-registration is a process of gathering all registration information that includes the benefits and authorizations, eligibility before the arrival of patients for outpatient and inpatient procedures.
Registration : The term registration refers to the complete set of data elements that are required in establishing a Medical Record Number, financial and clinical requirements and satisfying regulatory.
Remittance Processing : Remittance Processing denotes the process of applying and posting payments or adjustments to the appropriate accounts that include rejects too.
Third Party Follow-up : It refers to the process of pursuing collections from insurers after the initial claim has been filled.
Utilization Review : It is a process of assessment of the necessity, aptness, and efficacy of the use of medical services and facilities that includes the length of stay, services performed, regular reviews of admissions, and referrals.
After discussing the myriads of benefits that a revenue cycle management system provides, it won’t be an overstatement to say that by using these systems for Medical Billing, companies can reduce coding errors and revenue gaps and enhance their organization’s performance by sorting billing data.