Ann MacleanMany of us have this query in mind, especially if we are connected to health care sector. Revenue cycle management in simple terms is a process that manages insurance claims processing, payment, billing and revenue management. More, in a nutshell, it means managing the cycle of revenue in such a way that a health care professional gets paid correctly on-time. Nowadays, whether it is a large chain of hospitals or an individual physician or anyone else belonging to the medical field, outsourcing to a Revenue Cycle Management service is the best idea to manage revenue very efficiently.
Revenue Cycle Management Importance
Manage revenue collection for services rendered
It is estimated that 3 out of 5 hospitals lose on their revenue because of their revenue cycle mismanagement. The task of retrieving income from all sources has become a task of utmost importance for everyone in the medical field to thrive in this competitive and unstable economic
market. Most of the losses that occur in a hospital or any other medical organization is the result of poor management of data at the front-end, which further on, leads to unwanted complications throughout the cycle.
Many hospitals and individual doctors face problems as they do not get paid properly from both the patient end and the insurance company end for the services that they have already rendered. There are many revenue cycle management service providers out there who work with an ultimate goal to help their clients with extraordinary medical billing services, which in turn help them to increase their revenue. Revenue cycle management not only takes care of the claims and manages revenue but also takes up various other roles and accomplish them.
Collect patient insurance information
Patient’s insurance information is really important for any hospital or individual doctor’s office to acquire claims. There is many hospitals and doctor’s office out there that reject a patient’s call outright saying that they don’t have time for noting down the insurance details. But, this should be done before the appointment and any revenue management system takes care of this. This can be called the starting point and the ending point in a cycle. If this is done properly on-time, then the whole cycle goes on smooth without any hindrance.
Patience eligibility verification
Eligibility verification is also an important step. Most of the insurance claims have been denied due to the eligibility issues. But, these service providers do an eligibility check even before the patient visits for an appointment. At times, if there is an issue with the first round of eligibility verification, then the patient’s appointment is rescheduled. Usually two to four individuals in a service provider’s office work on the rejected claims and verification.
Verify patients billing information
Usually, accumulating patient registration and billing information is a crucial step. If the numbers go wrong, then the whole process goes wrong. Mostly, these agencies have appointment personnel who cross verify the information. This cannot be done in a regular doctor’s office, as it is a time-consuming process.
Claim submission and remittance
These service providers also have a proper electronic claim submission and remittance process. This speeds up the process. The patients are also offered an online bill payment and statement, which saves a lot of time and at the same time speeds up the process. Whether the insurance company has to pay or the patient has to pay, revenue cycle management service providers keep a clean watch on the revenue cycle in order to avoid any unnecessary impact on the whole system.