Healthcare organizations—hospitals and clinical practices—treat patients and save lives. However, to remain financially healthy themselves, they need to develop proper processes and policies.

Healthcare Revenue Management is used by facilities to overlook the administrative and clinical functions related to claims processing, payment, and income generation.

The full process involves identifying, managing, and collecting payment received from patients. Read this article to discover more about Healthcare Revenue Management as a whole.

Cycles of Healthcare Revenue Management

The process starts with a patient making their initial appointment for medical services and ends after all payments are received.

It sounds simple, but there’s more to it than meets the eye.

After booking an appointment, the administrative staff has to follow through with all behind-the-scenes actions like scheduling, checking insurance, and setting up the patient’s account.

  1. Pre-registration is an important part of the process, which provides the patient with an account, including their medical history and insurance coverage.
  2. Then comes registration, where the patient’s information is verified and secured by the healthcare provider. Co-payments are collected, financial documents are signed, and insurance is set up.
  3. Charge capture can be either automatic or manual. Information either goes directly to the practice management or the front desk staff enters it manually.
  4. Claim submission involves sending information to the insurance carrier after entering charges for the procedures. If claims are clean, the money comes through faster.
  5. Healthcare practices are liable to receive remittances once their claims have gone out.
  6. The sixth step is insurance follow-up, where healthcare practices check how much has been paid and how much is yet to be paid.
  7. The final step is patient collections, which involves collecting payments from patients. 

The ideal time of collection is when the patient is in the care of the healthcare providers. Therefore, front desk staff is trained to collect payments when offering services to reduce the backlog of payments.

Lack of Digital Automation

Certain complications arise if a system still employs manual paperwork and data entry. Creating a strong IT infrastructure can complement healthcare revenue management and create a more streamlined digital workflow.

Some other pros are flawless communication between different departments and no lost paperwork.

Administrative Staff

It always helps to hire competent staff members who have had previous experience collecting various kinds of payments. They can help put an efficient system in place where there’s less back and forth communication and hence less lost time.

A healthcare organization might also find it smart to outsource its efforts and find a dedicated partner with an established portfolio. This is especially helpful if the organization is struggling or has an inefficient system in place for whatever reason.

It might take a while for small practices to hire the correct people, provide the right training, and implement a strong Revenue Cycle Management (RCM) system.

Organizations may find an important move to offer staff personal and professional development opportunities such as mentoring and training programs.

The employees are responsible for the financial outpour from billing and payment collection, so it makes sense to keep them happy and engaged.

Benefits of RCM

It is totally up to the organization to either invest in RCM software or outsource RCM to a partner with deep knowledge of ICD-10 codes.

RCM software is fine to use by itself or may integrate well with other software such as Electronic Health Records (EHR).

Some benefits of RCM are:

  1. Saves time by automating tasks like managing appointments, fee collection, and reminders.
  2. Figures out exact reasons why insurance companies deny claims to find a fast solution.
  3. Accurately finds information regarding insurance status.
  4. Analyses reasons for revenue shortfalls.

Final Words

It’s important for the healthcare provider to be well aware of the chinks in the system to detect issues early on so that they do not affect the organization’s financial viability.

It is vital for staff to be well aware of the core complexities of the system and exactly which step correlates to which problem.

Pre-registration is one way to verify eligibility at the start of the process and avoid claim rejection, and RCM software ensures timely reimbursement.

There is no right or wrong. The healthcare organization must weigh the pros and cons to arrive at the best solution for their financial needs. The J3 RCM team has served numerous clients successfully by catering to their every need and personalizing our services. Start your RCM journey with us today.