What Are The Key Steps In Every Healthcare Revenue Cycle Management Process?

To move towards value-based reimbursement and more holistic patient care, healthcare providers need to look closely at the path to revenue cycle management. Poor billing practices can lead to financial losses and jeopardize the ability to provide quality care.

Revenue Cycle Management

Revenue Cycle Management (RCM) is a financial process that utilizes medical billing software used by healthcare facilities to track patient service portions, from registration and appointment scheduling to the final payment.

Healthcare RCM is a process used by the healthcare system to track the revenue stream from the initial visit of medical service beneficiaries to their balance payment. The earnings cycle begins with a patient’s hospital visit and ends with full payment to the provider or hospital for the services provided. 

RCM Outsourcing

Many providers invest in Healthcare Revenue Cycle Management (RCM) software, typically a Practice Management product. Healthcare business process outsourcing, or simply healthcare BPO services, means outsourced business activity or process that provides administrative and processing support to medical canters, staff, and organizations. Commonly outsourced activities include maintaining patient records, coding, billing services, etc.

When an organization lacks the resources to fulfill its RCM management service needs, outsourcing the healthcare process to experienced revenue cycle management BPO companies is a great option. 

In most practices, outsourced healthcare revenue cycle management services benefit from healthy revenue collection.

RCM Steps

The revenue cycle management process consists of seven steps: pre-registration, registration, bill capture, claim submission, remittance, insurance follow-up, and revenue collection. 

[1] Pre-registration

This step captures the patient’s demographic and linked insurance information to create a patient record. This stage determines the eligibility for online coverage, referrals, and any limitations verified online by the patient’s insurance agency. This step also collects information regarding the financial needs of the patient. This process allows the medical practice to set the financial terms of payment. 

[2] Registration

The registration process ensures that patient information is accurate in all cases. Here the provider ensures that the patient’s basic demographic and insurance information are correct and that the patient gets treatment every time. Important information on insurance providers, policy numbers, and medical billers is verified at this stage. The data is recorded in the patient file and used while processing the bills. Collection of co-payments and validation of expert referrals are verified. The financial responsibility of the patient’s insurance details is checked, and qualified procedures and services are mapped. In addition, at this stage, the financial form is signed and insurance benefits are assigned. 

[3] Bill capture

During check-in, patients are required to verify the details in their file; the cost incurred during their stay is captured from time to time. This is either automated in the practice management billing system or done manually where desk staff enter the information or share it with the billing department. This step follows the coding of the billing fee and sending it properly to the insurance carrier. The Revenue Cycle Audit typically checks for missing charges and tracks incorrect code charges. 

[4] Claim submission

In this step, medical billers create superbills that comply with medical coding standards and HIPAA and payment standards. The Revenue Cycle team scrubs claims, verifies charges, checks CPT codes as well as diagnosis codes, and verifies whether they support the diagnosed treatment and procedure. The claim is then transmitted electronically to the clearinghouse by the practice management team. Third-party liaison between provider and insured mailroom distributes claims to other payments. The details in the transmission report capture the statistics and status of the claim and the reasons for denials or deficiencies, if any.  

[5] Remittance

The remittance process entails that the details of the remittance benefits are given against the practice of the services provided. After the remittance is posted, the insurance company pays the sum of the allowable fee and fee schedule as agreed in the contract. Also, red flags are included without any authorization and/or approval in case of disputes. In addition, the company also marks the write-off due to the difference in rates as per the agreement.  

 [6] Insurance follow-up

Here the practice examines the relevance of what was paid on time and what was not, such as receivable reports and appeals or re-submission history. The cause of the delay and any errors are then corrected in the final report.

[7] Collection

The patient collection process involves standard practice for collecting co-payments and deductions to set financial expectations. Front desk staff actively work on outbound routine patient statements to help collect patient service revenue on time.

Benefits of Outsourced RCM  

RCM is a primary driving process that affects the medical practices and cash flow in hospitals. This process forms an integral part of any healthcare organization’s success. Therefore, an efficient billing system should collect revenue from patient payments, repayment of payments, and medical practices in other streams of revenue running their services.

Adopting consistent and streamlined revenue cycle analysis services brings uninterrupted operation and patient satisfaction.

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