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Many hospitals, clinics and medical facilities run short on resources and time. In addition, many employees have to perform several roles and responsibilities, which makes it hard for them to stay on top of all the tasks without making mistakes. Billing problems are often due to human error. Hospitals rely on inefficient manual processes for billing data entry, which leads to mistakes.
Healthcare providers who want to succeed in the long term must ensure their revenue cycle management efforts are running smoothly. Running a sound RCM program can be a boon to their financial well-being and ability to properly care for patients.
What is Healthcare Revenue Cycle Management?
The revenue cycle is the process used by healthcare systems in the United States to track money from patients from their initial appointment or encounter with the healthcare system through to their payment of balance. Healthcare revenue cycle management (RCM) is the process by which health systems bill for services and generate revenue - from patient intake to payor acceptance of final payment.
RCM is the process that links administrative information, patient's personal information, clinical data, insurance companies' names and medical codes with billing information. Revenue cycle management is one of the building blocks of health information management.
The Importance of Revenue Cycle Management for Healthcare Services
The revenue cycle management (RCM) department is a key part of the organization’s overall mission. It plays a crucial role in ensuring a health provider’s sustainability.
The revenue cycle is made up of the following steps:
Healthcare facilities must collect certain information from a patient before they can submit a claim. Charge capture, also known as billing, is necessary to determine the patient's coverage. Doctors provide their notes on the prescribed treatment, which are translated into codes for invoicing purposes. The health insurance provider uses these codes to determine reimbursement amounts.
After fees are added and coded, the insurance claim is sent to the patient’s insurance company.
Managing the Claim:
During this step, the hospital or clinic communicates with the insurance company to establish coverage levels so that mistakes or denials can be avoided.
Collecting Payment/Capture Claim:
Once payments from the insurers are received, a hospital or clinic will send an invoice to the patient for any outstanding debt. This may entail setting up payment plans. The provider will use billing software to optimize cash flow.
Accounts Receivable is the amount that a business is owed by clients for services rendered in the past. The Accounts Receivable team's purpose is to collect payment for partly/underpaid insurance claims.
Follow-up is the key to accounts receivables. Follow-up takes two forms: 1) Insurance follow-up, which is collection from the insurance company, and 2) Patient follow-up, collection of any outstanding payment that is the patient's financial responsibility (copays, coinsurance, or other out-of-pocket medical costs).
That’s why Jorie is leading the industry-
Jorie’s AI-powered revenue cycle management technology is an integral part of a healthcare organization’s success, helping you manage every step of your RCM procedure..
Jorie provides industry-leading Revenue Cycle Management services. With a proven track record of helping dozens of healthcare systems achieve million dollar growth in their medical billing and payment collections, Jorie knows how to get the job done correctly and on time.