Editorials by Jorie

Revenue Cycle Management To Decrease Costs and Succeed In Medical Billing

Updated: Nov 10, 2022

Revenue cycle management (RCM) refers to the financial processes that healthcare facilities use to track patient care episodes from registration and appointment scheduling to the final payment of a balance.

In order to properly complete the revenue cycle management process, communication with health insurance companies is necessary. When a patient schedules an appointment, the physician's office or hospital staff typically check the patient's reported insurance coverage before the visit.

After a patient is treated for a condition and pays any applicable copayment, the healthcare provider or coder categorizes the nature of treatment according to ICD-10 codes. Health care providers often purchase designated revenue cycle management systems to store, manage and track patients' billing records. An effective revenue cycle management system can reduce the amount of time between providing a service and receiving payment by interacting with other health IT systems as patients move through the care process.

A revenue cycle management system can help healthcare organizations reduce costs by streamlining administrative tasks that were previously performed by employees. These duties include informing patients of upcoming appointments, reminding payers and patients of an existing balance, reaching out to insurers with specific questions when a claim is denied, and automating many other routine processes.

Revenue cycle management systems can also save providers money by helping them identify why claims have been denied. Specifically, a revenue cycle management system can reduce the number of claims that are denied by prompting healthcare employees to enter all the information required for claims processing. This saves providers from having to resubmit claims and gives them a better understanding of why a claim was denied, thereby enabling them to rectify the issue. This also ensures that providers are reimbursed properly for taking care of patients covered by Medicare.

Experts believe that revenue cycle management systems will also help the industry transition from fee-for-service to value-based reimbursement. The analytics involved in these revenue cycle management systems allow payers and providers to get a more detailed look at their patient population, for example by analyzing which portion of the population is suffering from which chronic diseases, as well as allowing them to monitor claims data and pinpoint any abnormalities.

The healthcare revenue cycle management process is the financial method that facilitates the management of administrative and clinical functions associated with the claims processing, payment, and generation of revenue. It is applicable to providers of healthcare services.

In the recent past, hospitals in developed countries have also used big data analysis and artificial intelligence applications in areas such as denial prediction, coding, billing and pre-certification. The healthcare sector is growing rapidly and the adoption of healthcare revenue cycle management systems will increase, thereby driving the expansion of the global healthcare revenue cycle management market.

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