Revenue Cycle Management in Healthcare

To deliver a successful and efficient treatment process to a patient, healthcare providers use methodologies that can reduce their financial transactions with the patients and let the staff enable to look after other tasks as well. For the same, many medical practitioners use billing software that can verify insurance or claims and handle payments before, during, or after an appointment.

Revenue cycle management for healthcare is defined as a combination of essential financial processes, which includes, health information management (HIM), maintaining electronic health records (Her), and methodologies of managing patient’s privacy

Revenue Cycle Management Steps

The revenue cycle for a healthcare involves the following 7 steps:-

Step 1: RCM Software or Outsourcing Processing

The very first step in RCM is to decide how to handle the process of the cycle. If your organization is big, and you have a skilled IT team who have experience in using software for medical billing, you may prefer to install the software on your server. Besides this, you also have the option of outsourcing this process if your organization is too large.

Step 2: Patient Pre-Authorization

Pre-authorization of medicine or procedure is important and is the second most important step of RCM. As per the US Government, pre-authorization is defined as a

decision of a plan or insurer, that a medication, surgery, service, or equipment is medically necessary. And it is healthcare providers and patients responsibility that to double-check the coverage in case of any doubt.

Step 3: Eligibility & Benefits Verification

Checking and verifying eligibility and benefits is the 3rd most important step. There are many technologically advanced medical software available that automatically checks these details of patients and help in speeding up the work.

Step 4: Claims Submission

After verification, the next step is to claim the submissions. Here again, practice management software enhances the efficiency of the workflow by automatic and error-free submissions.

Step 5: Payment Posting

The payment posting is the further step where RCM software generates billing statements via Electronic Data Interchange (EDI).

Step 6: Denial Management

If you have received too many denied claims, it is time to investigate the matter. Denial management can help in recovering revenue. This will also boost earnings if money has lately been slow because of problematic claims.

Step 7: Reporting

Reporting is the last most important step which represents some of the hidden problems that can grow and cause a huge loss in the process. RCM software checks your financial data, management information and key performance indicators to see if your team is meeting benchmarks.