Revenue Cycle Management

RCM or Revenue cycle management in a nutshell means that assured steps are taken to get paid for what is done and that one is paid on time. This is a process wherein the processing of claims, recompense and revenue generation is managed. For this process, adequate software and technology is required to track the claims processing, making sure payments are dealt with, approved and collected and also deal with issues pertaining to claim denials or rejections that can lead to a good proportion of missed revenue opportunity. RCM is done to address and avert issues and thus ensure a steady revenue stream.

The RCM sequence starts right from when the patient calls the practice for an appointment and the staffs take down the basic, relevant patient details and also insurance company name and number. The cycle ends when the account balance shows nil.

RCM includes everything right from establishing the patient’s insurance eligibility to collecting co-pays, effectual claim coding with ICD-10 forms, effective time management, efficacy, a provider or healthcare facility’s EMR choice all determine the RCM cycle.


Requisites for effective Revenue Cycle Management

Information gathering is vital- Some medical practices actually say that they don’t have time to attend to patient calls for appointment and verify their details and insurance coverage. This way, the practice is not verifying the patient’s insurance eligibility. Therefore, if the patient arrives for the appointment, then there is a considerable amount of time spent in collecting and verifying the required details at that time. Prior eligibility verification is best. And if the patient is ineligible, the patient can be informed and necessary steps can be taken after that. All patient details can be sent electronically to a clearing house for insurance verification in a bundle and this reduces the denied claims volume.

Eligibility Verification is helpful- Claims denial statistics pertaining to the last quarter of 2010 reveal that,450 claims had been denied the first time they were sent. The denial rate was 6.9% for a first-pass denial and more efficient medical practices recorded 3% denial rates. In this, due to insurance eligibility problems alone, 2,270 claims were denied.

Do it correctly with the right usage of numbers and automating services- Collecting exact patient details and billing information is the first, basic step. Then enter the charges in the CPT Service code and ICD-9 diagnosis code on a regular basis. Many practices have either contracted out their billing process or have automated their systems to check the ‘missing charge’ column as it is automatically cross-checked.

The RCM process is improved with claims submissions and release payment postings being done electronically. This saves a great deal of time and the time can be used effectively elsewhere. The RCM cycle can also be reduced by engaging in online bill payment and e-statement facilities.

Our services at HealthPay Inc. reflect a decade-long experience and expertise wherein we help our customers’ reduce their operating costs and increase their efficiency and revenue. Our adaptable revenue cycle management process can be tailor-made to suit your needs and specifications. Wherein, we will engage in the following processes to help complete the RCM cycle:

  • Patient Registration

  • Insurance Eligibility Verification

  • Claims Submission

  • Medical Coding

  • Charge Entry

  • Payment Posting

  • Denial Management

  • Accounts Receivables follow-up

  • Clearing off aging A/R

  • Charges, recompense and modifications, if any

  • Prompt service in payment approval

  • Reduced operational costs and expenditure

  • With HIPAA compliance, there is better scope for increased revenue

  • Round-the-clock services and good TAT delivery

  • We consistently follow-up on denied or rejected claims

  • Advanced technological advantage

  • Strict observance of the established guidelines, compliance measures and norms

  • Cost-effectiveness leading to maximizing revenue inflow

  • Bad debt reduction and minimum denials

  • Result-oriented timely delivery