Revenue Cycle Management: Primary Steps and Benefits

Every successful healthcare organization has one thing in common- a strong revenue cycle. If your practice does not have an efficient billing process in place, you risk losing thousands of dollars each year in-patient payments, payer reimbursements, and other revenue streams.

With a robust revenue management cycle, healthcare practices can thrive as it is integral to the growth of your practice. The healthcare revenue cycle is a set of administrative and clinical activities that contribute to collecting, managing, and analyzing patient service data. 

In other words, it’s a term that refers to a patient’s whole account history, from registration through bill payment.

 

Critical steps of revenue cycle management

    1. Pre-authorization and eligibility verification

Pre-authorization and registration are the first steps in revenue cycle management. A practice will collect the patient’s insurance and financial details at this stage. At present, automated eligibility verification systems serve providers by revealing how they will be paid for various services. The same can benefit patients by preparing them for their financial responsibilities.

Price transparency and insurance verification technologies in fully integrated practice management, and medical billing solutions can help improve this step in the revenue cycle management process.

    2. Charge capture vis-a-vis services provided

The second phase in revenue cycle management involves transcribing services given into billable charges, known as charge capture. The instant you assign a medical billing code to a claim, this stage of revenue cycle management becomes critical to the claims process. 

Your team can obtain access to critical coding tools that help you code more precisely, assuring timely reimbursement, with the help of good medical billing software. For example, scrubbing technology for claims will ensure that each claim is coded the first time correctly. It can save hundreds, if not thousands, of dollars in claim rework and administrative costs resulting from claim denials.

    3. Making a claim and handling the denials

The submission of a claim is the next stage in revenue cycle management. It is then up to you to submit the correctly coded claim to the payer when you have completed the charge capture process. This step can be strengthened with revenue cycle management software or an efficient RCM services vendor to track your claims in real-time and stop them before they are denied. 

Revenue management software ensures that your practice is filing clean claims at a rate of up to 99 percent, resulting in the quickest payout possible. In addition, you may automate this activity and give your staff peace of mind by outsourcing billing to an RCM provider with a competent practice management solution. 

    4. Payments

The payer reimbursement will be on its way when the patient’s insurer reviews the claim, and the out-of-pocket cost will be posted for the patient to pay. With an integrated billing solution, your patients may view and pay their bills directly into their patient portal. 

You can use your integrated practice management solution to notify patients about their invoices and push them to pay, resulting in more on-time and in-full payments. 

    5. Reporting

While collecting money is the final step in the revenue cycle management process, your practice also requires excellent reporting systems to help you stay on track and prevent expensive mistakes. 

Quality reporting options in your medical billing software can assist you in quickly identifying frequent revenue cycle management issues that are causing money to slip between the cracks. 

Your software and vendor can assist you in resolving these issues and protecting your bottom line. By recognizing trends and barriers in your revenue cycle, you can quickly minimize days in A/R.

 

Benefits of a strong RCM

Optimises workflow for better cash flow

When you automate most of the processes, you can improve the system’s efficiency and allow payments to be made on time. All of this while reducing errors and denials and increasing cash flow. 

By streamlining scheduling, coding, billing, and payment processing, a practice can create a more effective and efficient system. It can help free up time for non-administrative tasks like caring for patients and focusing on what you do best while still meeting your income targets.

It helps practices lighten the load

A well-oiled facility will assure consistent collections that keep your organization financially sustainable, but it will also reduce the administrative strain on your personnel.

Efficient software, in particular, can assist in streamlining all aspects of the system, such as synchronizing front and back communication, finishing a patient’s journey with timely payments, and removing misplaced paper documents.

Other benefits of a robust revenue management cycle include:

• Better claim scrubbing
• Fewer denials
• Faster collections
• Improved revenue

 

Join hands with the right partner: Capline Healthcare Management

Every step of the claim lifecycle is managed by revenue cycle management. Capline views every aspect of your billing process as a chance to improve income by finding and correcting the causative factors of any problem.

Capline Healthcare Management is one of the best revenue cycle management companies in the US. We understand how vital medical billing and collections are to your practice’s survival and growth. We also know how patient collections have become a difficult task for your team. 

As your consultant, we can help you develop a procedure for collecting at the front and back ends of the revenue cycle and supply collection workers. 

Want to know more? Contact us today!