Successful revenue cycle management plays a crucial role in maintaining and maximizing the financial health of your medical practices by assuring revenue collections promptly, making it feasible for medical practitioners to focus on delivering quality care to patients. Hence, your healthcare organization and health system must be sharply aware of the workflow processes and procedures to identify and overcome the challenges in your medical practices’ revenue cycle management. In this blog post, I will share eleven significant steps in revenue cycle management that will assist your workforce in streamlining operational procedures to get value-based reimbursements.
Healthcare revenue cycle management comprises the following set of functions that helps you to get a comprehension of how the system works:
As per the No Surprises Act and Price Transparency laws of federal healthcare authorities, the
healthcare systems must strengthen the patient experience by increasing transparency on the price rates
and RCM billing outcomes. What these transparency rules demand from the medical providers, Is to
establish a transparent conversation with the patients, and the patients must be primarily aware of what
they are signing up for before deciding what medical procedure will be performed.
Therefore, because of these circumstances, Selecting the best-fit revenue cycle management (RCM) system
that includes practice management software for your healthcare organization is critical for success.
Once you have deployed the modernized practice management system for your organization, the alignment of the staff must be your center of attention. It is the second crucial step in the RCM to organize the staff training programs periodically to ensure your staff is completely comfortable using the system as they are courageous in handling financial management since they are in charge of RCM on the ground level. Outsource your practice management to the healthcare administrative partner; You must ensure, that their ecosystem must be compliant with your existing RCM software and that you will assign your in-house staff that will be in correspondence with them.
You must streamline your healthcare revenue cycle management, allowing your patients to schedule their appointments directly through scheduling software. This self-scheduling will effectively maximize patient satisfaction by allowing practices to eliminate the time they spend booking appointments following a manual procedure.
The next step in revenue cycle management is to collect patient demographic data accurately after verifying the identity of the patients. Any changes in the insurance cards must be updated accordingly. If this process of initial touch-points is mishandled, it will lead to a series of ongoing issues, including devastating patients who may decide not to pursue their care at the cluttered faculty.
The patient’s Explanation of benefits is a most prior and crucial stage in the revenue cycle management where you receive an EOB document that briefly explains how your insurance carrier processes the claim for the rendered services. In practice management, you are required to verify the following information:
In case of any divergence in the verification process, you must connect to the patient in advance to maintain the transparency of the relationship. Moreover, it is also essential to update the insurance coverage to shield the patient from paying out of pocket, which could become difficult to collect.
A copayment is the fixed fee a patient is responsible for paying in advance for the required medical services. An insured person is also responsible for paying a flat fee in case his medical expenses exceed, which is called a deductible. A workforce in charge of revenue cycle management is responsible for collecting all the co-pays before the medical procedures are performed before the appointment. The reimbursement specialist recommends collecting the copays before the encounter instead of as part of the checkout process before the patient leaves the office. Once they go, collections become more expensive and more complex.
Charge capture is the process performed once the physician has provided his services to the patient,
where the performed medical procedures are transcribed into the billable charges. It is the most
critical stage in revenue cycle management as it involves assigning procedural medical codes in the
claim. The slightest mistake in the process can lead to the refusal of the reimbursement claim.
This process can be simplified by utilizing quality medical billing software where your workforce can
access essential coding tools to ensure accuracy in coding that results in timely reimbursement.
Moreover, a claim scrubbing technology also maximizes the accuracy of the coding in the first attempt,
saving thousands of dollars required in the recreation of the claim and administrative costs concerned
with the claim rejections.
The revenue cycle workforce is responsible for managing the workflow claim submission processes, including looking up the charges and the healthcare procedural coding implications for the performed medical procedures. Most often, this process is managed electronically using medical billing software; before the claim is submitted to the concerned insurance carrier, the claim is processed through the claim scrubbing stage, where the prepared claim is reviewed to ensure the claims are clean and are going out the door correctly. In a scrubbing process, a claim runs through an algorithm that identifies duplicate charges, typos, illegible content, or incorrect data and verifies all CPT codes are accurate.
When the reimbursement claim is submitted to the insurance carrier, two situations take place; either the claim is accepted or rejected. A dedicated team is associated with performing the denial analysis and finding the best possible solution to get the claim approved by the Payer.
Account Receivable Follow-up comprises a network of complex processes.
The workforce in charge of RCM is responsible for observing the AR’s current status and seeing if the
payments reach on time or not.
Following is the collection of processes that is a part of Account receivable management:
The Last but most crucial step in the revenue cycle management is the payment posting, which refers to viewing the medical practice’s payments and financial picture. It also involves logging the payments into the medical billing software. Furthermore, it comprises the following stages:
Posting insurance data from EOBS And ERA: Insurance carriers prepare an explanation of benefits document, which consists of a patient’s name, service dates, procedure codes, allowed and denied amounts, deductibles, and copayments, and then issue a check once a claim is processed.
Claims Reimbursement: The Healthcare provider receives compensation from the payer if the patient has signed the assignment of benefits documents; instead, the payment will go to the patient, not the provider.
Revenue cycle management ends once the healthcare provider has received the reimbursement from the insurance carrier for this performed medical procedure and services. If you do not track your medical practices’ revenue cycle management data, your workflow processes will continue, but the efficiency will be highly contrived. Therefore, your healthcare organization must invest in machine learning applications to perform detailed data analytics to diagnose the problematic areas in the medical methodology and optimize profit margins. You can understand how each type of data analytics plays an essential role in the revenue cycle ecosystem and how the operational processes can be optimized to minimize the cost just by using big data.
You can perform the following data analysis techniques:
Descriptive: In this technique, the organization uses historical, descriptive data to perform the data evaluation process; based on the results, the organization’s financial data is compared to the industry best practices benchmark, which gives the medical practices insight into the revenue leakages caused due by the internal operational and insurance carrier issues.
Predictive: Predictive analytics is a technique in which the organization’s data is processed using data mining, AI modeling, and machine learning techniques to predict what could happen in the future. Applying predictive analytics patterns to your RCM workflow processes can optimize overall efficiencies.
Prescriptive: Prescriptive analytics is a continuation of predictive analytics, which endorses the healthcare organization to practice the action to examine the potential results of each expected action. This analytical technique provides long-term recommendations to improve operational costs, maximize margins, and optimize payer-provider collaboration. At MedsIT Nexus we use data analytic techniques, to enhance our clients’ operational workflow and profit margins. You can also implement these to maximize your overall RCM performance.
MedsIT Nexus medical billing and coding services comprise a streamlined revenue cycle management solution that transforms your manual medical practices into electronic ones, which saves your valuable time and resources; this eliminates your involvement in administrative burdens and allows you to focus more on patient care. Ultimately, our AI-empowered RCM workflow processes facilitate your organization to build a steady stream of revenue.
Claim Free Practice Audit
© MedsIT Nexus. All rights reserved 2025. Powered by MeshSq.
