Revenue Cycle Management

FAQs on Revenue Cycle Management

What are RCM services?

RCM services refer to all the administrative duties and tasks that constitute the capture, management, and collection of revenue offered by your patients.
Depending on the size of your health institution, you might opt to deal with RCM services in-house. With time, your increased operations and scope will require you to hire a third party for more professional RCM services.

What are RCM services?

There are many things you’ll need to be on the lookout for, but most importantly is the reputation of that particular provider. For a start, make a comparison with various providers, read their customer reviews on Quora and leading industry publications. This will help you see what others have experienced with that RCM service provider.
A good service provider should have a proven record of enabling health facilities to turn around their finances. What is their client base? How many years of experience do they have as an RCM service provider?
Evaluate your prospect by analysing their professional affiliations. Customer service is also a key component you need to consider. A good provider should be able to respond to calls from their clients who need help at anytime.
To stay ahead of everyone else, your service provider should embrace continuous learning. Ongoing training and certification of its staff will ensure that the team remains appraised of all current trends in the industry. This will help guarantee that employees are aware of any changes in the RCM guidelines.
It would also be useful to inquire from your colleagues about their opinion on the current RCM service providers in the market if they’ve tried any of them in the recent past.

Are certified coders in charge of your account?

Authentic service providers are key elements in any industry, especially the health sector. In medical billing, most of the claim rejection comes from wrongful coding. This is why it is critical to ensure your service provider is working with certified coders.
A certified coder without a doubt means that they are properly trained and qualified on matters regarding coding.
Coder’s certification is undertaken by the AAPC and the AHIMA in the United States. They ensure their members can demonstrate practical coding experience. They also ensure members have the required pass for getting coding credentials. Certification is done on a rolling and renewal basis to ensure that the coders continuously update their knowledge in matters coding.

How much does RCM Services cost?

Every organization wants to be appraised of the cost of integrating RCM services. This is helps you to better understand the cost impact on your organization. It is important to note that the cost impact will be different in each case. For instance, it will be dependent on the number of patients you serve, the different insurers you’ll be dealing with and your amount of patient encounters. The state your practice operates from also plays a huge role in the cost implications of RCM on your organization.
Due to the various uncontrollable factors that affect the cost of RCM, it is prudent to instead look at how much your practice will save in both the short and long term.
Hiring new staff to handle the increased revenue compared to the cost of doing the same using a certified RCM service provider will give you a better perspective of the cost benefits.
RCM has many cost advantages, including minimizing losses that arise due to claim denial and speed of revenue flow when a good RCM provider is hired.

Does the provider offer denial management on current claims?

Claims denial forms a persistent source of revenue losses. This is why you need to employ an RCM service provider who will offer you proper claim denial management on your current claims. According to HealthCare News,most executives of health facilities use an RCM vendor to manage their denied claims. Only 31% use manual processes,while another 18% of executives prefer using in-house tools to manage denial of claims.

Outsourcing RCM services to seasoned professionals improves your practice’s bottom line. It will bring down the number of denied claims considerably.
A common solution process employed by RCM vendors when dealing with claim denial management is automation of tasks, which easily shows the source of a claim denial. The automation also subsequently speeds up the resubmission process.
Organizations that rely on outsourced RCM services can improve their bottom line when they rely on experienced professionals to lower the number of denials as much as possible. Part of the solution is for the RCM services provider to automate tasks to get to the root cause for denial and speed up the claim resubmission process.

Will they analyze and track all of my rejected claims?

What is causing so many rejected claims for your organization? A knowledgeable medical billing service provider can effectively tackle all the denied claims for you. They take up less time to get to the root cause of the claim denial compared to your staff.
The data analytics provided by your providers as to why certain claims are denied more frequently compared to others will prepare your staff on how to deal with such in the future. Data analytics is essential in determining quick future payments that are made on time as compared to the waiting that comes with clearing up coding errors and all the common issues that normally delay your income flow.

Will investing in RCM Services make us a better practice?

The goal of RCM services is to improve the bottom line of your practice. Bringing professionals into the picture who are well versed with efficiently dealing with issues that compound revenue loss can help make your practice better. You can also expect the RCM service vendor to be adequately updated on RCM best practices.
Additionally, investing in RCM services gives you an extra pair of hands. This allows you to focus more on patients’ well being as the RCM professional labour for you on the revenue collection side.

Will investing in RCM Services save us money in the long-term?

How much time and resources does it cost you to request claims workers to handle the claim processing? If you continue handling these tasks in-house, think of the cost in terms of time and resources that you stand to incur. Recruiting and evaluation of new billing staff, as well as their ongoing training and certification, can take a big chunk of your profits.
You can choose to invest in an RCM service provider to save you all that hassle. Moreover, such companies work with professionals who are passionate about their job and who want to build and maintain a good reputation for working with a company that is focused on revenue management.
Take advantage of the expert’s efficiencies and expertise to streamline your revenue flow. They’ll do what you’ve struggled to do in-house but only in a better and quicker way. This will speed up your income flow, which also equates to more disposable income at your organization.
That is what will make your practice better in the short and long term if you choose to invest in RCM services.

Why shouldn't I just manage my billing in-house?

No law restricts you from taking care of your billing in-house. It is especially not an issue if your practice deals only with a few patients and fewer insurance providers. Dealing with billing in-houses in such cases helps to keep your services lean and small.
However, this means more work handed over to your staff. Besides, in case your staff are on sick leave or vacation, this can cause a huge inconvenience. You’ll be required to hire replacement workers temporarily. If not, then you’ll be forced to divert your in-house human resources, which then forces you to make up for the staffing deficit in your budget. This will eventually eat into your profits.
In-house billing deprives you of the chance to work with third party professionals who are experienced and dedicated in matters of revenue management. The expertise they have garnered from always focusing on RCM for different health organizations can be of great value to your practice.

Does the billing company prepare you ahead of time for fee schedule changes?

Have you considered that your revenue losses are due to your team not being appraised of governmental and industry changes with regards to the payment process for medical services provided? For instance, Medicare updates it’s fee schedules periodically, and your staff needs always to be updated of such. Moreover, they should always anticipate what to expect in the near future.
RCM service providers you hire should also monitor such information. If you’re well prepared in advance about any changes in fee schedules, you’ll easily plan, especially if you expect your income to dip the following year after the revised fees. RCM service providers, therefore, make up an integral part of your yearly budgeting.

How does RCM work in medical billing?

Note that medical billing denotes the paperwork that goes into the filing of medical claims for reimbursement from an insurance company. On the other hand, RCM includes services such as reporting and analyzing the flow of income as well as the patient’s financial services. RCM extends over and above filling out medical billing claims.
Medical billing is just a subsection of financial management that we refer to as RCM. Revenue cycle management is crucial to your organization’s successful handling of medical billing processes. It supplements the billing components by analyzing, tracking, and managing the process of patient claims on accounts receivables.

Want to find out how we do it? Read on, or contact us for a quick chat.

What are the six stages of the revenue cycle?

Step 1: Patient Pre-authorization

After procuring an RCM software, the first step in the revenue cycle is the patient pre-authorization. According to the U.S government,it is defined as a decision by a health insurance company to acknowledge the necessity of prescription medication, medical procedure or service and equipment. In case of a medical emergency, the patient’s pre-authorization is often an exception.

Step 2: Eligibility & Benefits Verification

The second stage is the front office’s task of checking the eligibility and benefits of the patients according to their insurance cover. RCM software helps to speed up this process as manual tracking over the phone can be gruesome and quite tedious.

Step 3: Claims Submission

After the eligibility verification, the payment process only becomes forthcoming when a claim is submitted. RCM facilitates the claim submission process flawlessly and speedily. Automation of this process saves time and provides the option to submit claims in batches. It’ll also help to detect any errors in the claim submission process. RCM service providers also make claim resubmission a quick task.

Step 4: Payment Posting

The payment posting step is where the insurer is now able to pay for the services received by their subscriber. RCM software generates billing statements conveniently. You can also use the system to send messages to patients electronically with a “click here” to pay option to encourage them to reimburse you more quickly.

Step 5: Claim Denial Management

How frequently does your facility get its claims denied? The claim denial management stage is set up to investigate and minimize revenue losses due to denial of claims.
When properly executed, denial management can significantly boost your organization’s earnings, especially if money has lately been slow because of problematic claims.

Step 6: Reporting

Reporting is the final stage of any revenue cycle process. This stage generates reports for your meetings to help your organization plan and meet future targets quickly and easily.
It is good practice to utilize RCM software that can customize reports, including financial data, management information, and key performance indicators.

What is RCM in audit?

Your medical organization needs to perform revenue cycle audits at least once every 3 months. Depending on the size and scope of your practice, you might need an audit once every month.
Technological advancements are steadily evolving. This has forced companies to integrate EMR and billing systems.A review of each patient encounter is necessary,especially at the point of occurrence and before the bill is sent to the insurer.
The purpose of RCM in audit is 2-fold;
Audits in RCM captures insight into how well the overall process of revenue capture is working.

What is RCM in risk management?

In risk management, RCM is mainly used to develop a list of maintenance tasks and strategies. The RCM maintenance tasks are based on; how reliable the system is, the components of the system and the failure impact. This is how RCM and Risk Management go hand in hand.
The 7 common steps between RCM Process and risk management are:

What is the revenue cycle process?

The revenue cycle constitutes all the administrative as well as clinical functions that contribute to the capture, management, and collection of revenue of patient services. In the most basic terms, it is the entire life cycle of patient accounts from creation to the payment.
Your revenue cycle process must integrate best practices for billing and collection of payments in accordance with insurer or payor requirements. All services within the revenue cycle must be paid in full.

What is front end revenue cycle?

The front end revenue cycle is made up of the patient scheduling, registration, insurance eligibility verification and authorization, and finally, the upfront patient collections.
The front end revenue cycle relates to the processes of direct patient interaction. However, it is different from the back-end since the latter relates to claim management and reimbursements. Although they operate differently, the front-end is critical to the success of the back end processes.
All medical billing processes commence at the front desk. And there must be synergy between the front and back-end process for a successful revenue cycle.

What are the five business activities of the revenue cycle?

In business, the revenue cycle relates to activities that constitute the exchange of goods and services for monetary payment. The revenue cycle business activities may vary slightly depending on the size and type of business but are basically categorized into the 5 activities below.

1. Selling Product or Service

The cycle starts with the selling of a service by a business company to a client. This stage involves proposals and pitching to potential customers. The proposal includes disclosing terms of the sale, warranties, and any incentives that may be provided.

2. Documenting an Order

In business, the revenue cycle relates to activities that constitute the exchange of goods and services for monetary payment. The revenue cycle business activities may vary slightly depending on the size and type of business but are basically categorized into the 5 activities below.

3. Service or product delivery

Service delivery is the revenue cycle process at the center of a company’s business activities. It is a critical stage that affects the subsequent stages, especially in case of any delays.
Verification of any information on the business contract should be done to avoid costly mistakes in the revenue cycle. Besides, changes made during the delivery stage of the revenue cycle necessitates a review of the entire contract to incorporate the changes.

4. Billing

As with any revenue cycle, billing is the business activity that is most looked forward to by the business entity. The time taken by this process depends on how the practice operates.
Some businesses work on pre-payment while others operate on post-payment. The billing can be done prior to or after the service has been delivered, depending on the mode of payment.

5. Collections

The last business activity is the collections. This is where a medical practice puts measures in place to collect any outstanding patient payments. Some practices may write off some debts as bad debts while others pursue other means of collection to recover their payments fully.
The collection process is just as essential as a business activity as any other; hence requires serious analysis. This will help to modify previous activities so as to collect more money and streamline the revenue cycle of a business.

What is the difference between RCM and FMEA?

RCM as a tool is used to ensure that a process such as the revenue cycle of a practice is reliable. This is done by designing the inherent software functions, functional process failures such as the coding and billing process, modes of failures, as well as the impact of the failure (for a medical practice this is likely revenue loss.)On the other hand, FMEA is mainly used to reduce risks before a process is implemented.
In addressing equipment functions, RCM addresses performance standards as well as asset functions while FMEA functions are higher and do not, therefore, address performance standards.
These are the most frequently asked questions concerning revenue cycle management processes and best practices. Understanding them will help your practice to navigate the revenue cycle efficiently and reduce revenue leakage points and denial of claims.
A medical practice that addresses these questions correctly will eventually enjoy a streamlined RCM process and increase its income flow.
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