What is Revenue Cycle Management?
Revenue Cycle Management (RCM) is a crucial aspect of any hospital or physician practice. RCM is the process of settling claims, processing payments, and generating revenue in the healthcare industry. The RCM process kicks in when a patient makes an appointment and ends when his or her account balance becomes nil.
How does the RCM process plan out?
After a patient books an appointment, the healthcare center looks into the patient’s insurance coverage before the visit.
Following the diagnosis of an insured patient, he or she provides applicable copay. The healthcare provider or a coder categorizes the nature of the treatment based on the coding norms (ICD-9 or ICD-10). The hospital forwards the case summary classified with codes to the patient’s insurance firm to see the procedure of treatment covered by insurance.
How is CRM beneficial?
● The business and clinical side of healthcare work in proximity.
● Healthcare providers preserve and manage patient’s billing records using a CRM system.
● It minimizes the time between providing service and receiving payment for it.
● Healthcare practices save time when they allow the RCM system to perform tasks automatically.
● It reduces the number of denied claims, saving healthcare providers money.
● It enables the staff to input all the required information for claim processing and avoid resubmission of claims.
● RCM simplifies the process of communicating with the EHR and accounting system.
● RCM facilitates the purchase of analytics software and use of dashboards to determine or monitor revenue goals.
The system of Revenue Cycle Management can disrupt a hospital or physician practice if not implemented correctly. Therefore, select an RCM system wisely and ensure its proper implementation.