Introduction:

Financial performance and any organization can be boosted only through revenue cycle management (RCM). It is a process of managing the financial aspects of an organization linked with clinical and administrative functions. Financial cycle management involves patient eligibility verification, patient registration, claim submission, reimbursement and collection through utilizing medical billing software. Healthcare organizations use Revenue Cycle Management to track the episodes of patient care from registration, appointment, and scheduling, final payment and revenue generation. The goal of revenue cycle management in medical billing is to enhance revenue generation, reduce the risk of financial losses, improve cash flow and stay in operation to treat the patients. Following five essential steps to boost the bottom line to enhance effective revenue cycle management are as following

1. Table of Contents

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   Patient eligibility verification and registration

Patient registration is a crucial step in Revenue Cycle management. It is required for capturing the patient’s insurance and demographic information. It helps to prevent billing errors and reduce claims denials. It involves verification of eligibility of patients and also coverage of rendered services. It optimizes revenue cycle management. From the perspective of a healthcare organization accurate demographic and insurance information reduce rework throughout the revenue cycle and eventually reduce the risk of potential rejections.

2. Improve strategies for Revenue Cycle Management

Right after the submission of a claim, the organization needs to track the claim progress to enhance the Revenue cycle management. It is done via monitoring the claim status, identification of any rejection of denials and also promptly addressing them. Electronic claim submission systems also help to reduce manual errors. Regular claim monitoring, delayed follow up and appeals of incorrect claims also contribute to enhancing the Revenue Cycle Management (RCM).

3. Optimization of coding documentation

For accurate reimbursement, medical documentation and medical coding are essential. Compliance with regular audits with the coding guidelines along with accurate medical documentation also reduces the risk of audit denials and penalties. Medical coding involves translating procedures, diagnoses, and services to standardize codes for refund and billing purposes. Coding staff training to assign procedure code and appropriate coding based on the record of patient help to boost the revenue cycle management. The code identifies correspondence with treatment and determines how much the healthcare entity will receive from the health plan of the patient. The selection of appropriate code also reduces the risk of claim rejection and contributes to enhancing the revenue management cycle.

4. Reimbursement and collection of revenue

To reduce confusion and enhance transparency is essential to implement clear and concise patient billing statements. The use of multiple payment options like automated payment plans, and online portals streamline the revenue cycle management process. Training of staff for effective communication with the patient is also essential. It helps staff to effectively communicate with patients, offer financial assistance and get them to know about the coverage details as well payment options. Right after the approval of the claim, the healthcare organization receive payment from the payer. Reimbursement could be in the form of adjustable payments, direct payments or contractual write-offs. Efficient collection of revenues ensures the accurate posting of payments, identification of underpayments and pursuit of outstanding balances from payers or patients.

5. Implementation of performance metrics and data analytics

The use of key performance indicators (KPI) and data analytics monitor the performance of the revenue cycle and identify the bottlenecks to drive the continuous improvement of revenue cycle management. Data analytics core focus is departmental sales, inventory and finance. KPIs with data analytics offer valuable information that correctly aligns with the goal of revenue cycle management. Measures matrices are claim rate, days in account receivable, collection rate and denial rate to identify the areas for optimization. Leverage technology to generate actionable insight and automate reporting. Tracking of the progress of claims is done right after the submission of claims. It involves the monitoring of claim status and identification of claims rejection or denials for revenue cycle management.

Conclusion

In the contemporary and uncertain industrial growth, the healthcare industry transit from free service to value-based reimbursement. That is why, there is a need to adapt Revenue cycle management accordingly. A holistic approach requires for boosting the bottom line of an organization. It works wonders when it combines with sales growth, operational efficiency, strategic decision-making, cost management and customer focus. Continuous reviewing and aligning the organization’s strategies with the customer needs and market changes would help to improve the bottom line.

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