Medical Revenue Cycle Management
Revenue Cycle Management (RCM) refers to the process of identifying, collecting and managing the practice’s revenue from payers based on the services provided. A successful RCM process is essential for a healthcare practice to maintain financial viability and continue to provide quality care for their patients.
The move toward value-based reimbursement and more holistic patient care has required healthcare providers to take a closer look at the way they approach revenue cycle management. Poor billing practices can result in financial losses and potentially put at risk the ability to delivery quality care. Striving to improve and streamline core operational procedures can help providers remain financially viable.
Revenue Cycle Management Challenges
The revenue cycle begins when the patient makes the appointment and ends with successful payment collection. However, there are many steps in between that must be accurately and efficiently completed to ensure timely payment. The opportunities for human error due to coding complexities, miscommunication, medical billing errors due to duplicate data, and missing information or misspellings can result in lost revenue.
The ever-changing healthcare regulations and reimbursement models can make receiving timely reimbursement challenging. This can also increase demands on staff time and often requires appropriate software technology to complete necessary reporting. Healthcare providers often work with limited available resources. For providers to achieve RCM success, it often requires focusing on improving efficiency with administrative tasks.
Factors That Can Affect RCM
The provider has little control over the payment from the claim review and denial process. Long waits for billing and claims to be processed for provider payments may result from claims denied due to insurance eligibility issues and the increasing efforts to combat healthcare fraud and abuse.
However, there are some internal factors that the provider may have some control over. Productivity, patient volume and collecting fees for service are areas that providers can concentrate on to improve upon their RCM.