Healthcare providers are always on the lookout for ways to improve the quality of care offered to their patients. However, the immediate concerns about collections and reimbursements are bound to get in the way when the unavailability of resources and shortage of financial automation tools become a consistent issue. Besides, using conventional methods to manage the healthcare revenue cycle in this age is not only a time-consuming task but also an unreliable approach. It’s impractical to calculate the exact spending and revenues while tracing every transaction manually.

This is where the healthcare revenue cycle management (RCM) benefits the physicians and patients, making the revenue collection process much easier for both parties. J3 Revenue Cycle Management is one of the best healthcare revenue management Fort Lauderdale companies to extend its services in this field.

To put things into further context, let’s learn about the ins and outs of this healthcare sector in detail.

 

What is Healthcare Revenue Cycle Management? – The 6 Steps to Know About!

The revenue cycle begins when a patient schedules their first appointment with a physician and ends with the payment collection for all the services rendered until their last appointment. In other words, healthcare revenue cycle management is the collection of payments from patients, including all their medical bills and expenses. 

Without this imperative RCM system at hand, medical facilities fail to offer undivided attention to their patient’s care. Here’s a six-step breakdown of how the revenue cycle works for the medical establishments.

 

Step 1 – Charge Capture

The data recorded by a physician about a certain inpatient episode is turned into a medical claims system for easy billing and collection purposes. This charge capture system is usually in correspondence with the EHR (electronic health record) systems.

 

Step 2 – Coding

A patient’s record is then encrypted with universally accepted medical codes, depending upon their reason of visit. Once this claim is submitted, insurers utilize these assigned codes to determine the total collection or reimbursement amount.

 

Step 3 – Claims Submission

Medical facilities also pass a claim for requesting payment from insurers, depending upon the pre-established rates for the performed medical procedures. Accuracy is of vital importance, in this case, to avoid any denial or rejected claims. 

 

Step 4 – Insurer Communications

Furthermore, the billing managers of a medical institution communicate regularly with insurers to work out precise patient coverage levels and reimbursements without encountering any error or denial. They may also need to go through contract negotiations with the insurers at this stage to come to a mutually agreeable decision. 

 

Step 5 – Payment Collections

Once the insurance reimbursements are received, medical facilities bill their patients for any remaining amount. This step often involves assisting patients in understanding how to set up adequate payment plans.

 

Step 6 – Medical Service Review

Finally, healthcare providers clinically analyze the patient’s treatment data to find ways that can help them lower their expenses while maximizing their resources. From evaluating medical resources to determining the best course of action, everything is considered to enhance the patient care level.

 

Major Benefits of Healthcare Revenue Management

Now that you realize how revenue cycle management works in the medical field, let’s summarize what benefits patients and physicians avail by being a part of this system:

  • Effective healthcare revenue cycle management simplifies the overall collection process by streamlining the system. This lowers the financial burden for patients and the administrative, focusing upon delivering the best care under a minimal budget.

  • Since RCM includes a coding system to work out patients’ medical bills and reduce redundancy, there are close to no chances of encountering an error in billing documents. 

  • With the elimination of errors, there are also fewer denials from the patient’s or insurer’s side.

  • Lastly, the revenue cycle system fastens the collection process since it automates most tasks and lowers the administrative burden significantly.

 

Our Final Verdict

Managing the RCM services in-house is an expensive charge, involving consistent effort from the management side as they operate multiple resources simultaneously. However, outsourcing these RCM services to a team of professionals that can allow medical facilities to focus on raising quality standards can elevate their revenue dramatically. As a result, errors are eliminated, collections reach maximum levels, and operational costs reduce.

Case in point, if you’re looking for the best healthcare revenue management Fort Lauderdale company, J3 Revenue Cycle Management can assist you at your convenience. For more information, visit our website or call us at (833) 974-2699!