At the end of the day, delivering high-quality healthcare services to patients isn’t enough to keep you in business; you also have to be successfully managing your finances. To do this, you must have a thorough understanding of each step involved with revenue cycle management.
RCM software or outsourcing processing
The first decision your practice will have to make is whether it will outsource its payment processing or use a specific software. This decision will largely be based on the size of your business, and the growth you are expecting to see. Managing payments internally can take a lot of time and resources, especially for larger businesses, so looking into outsourcing options might be a good idea.
Pre-authorization refers to whether or not a healthcare insurance provider deems services or procedures to be medically necessary. As the healthcare provider, you need to determine pre-authorization for all of your patients before delivering any services, to ensure you will receive reimbursement for this work.
Eligibility & benefits verification
Different patients will apply for certain benefits, and it is your responsibility as the healthcare provider to determine the eligibility of these. If your clientele is small, checking eligibility and benefits over the phone can be achievable, but there are also specific RCM software that can run this process for you, saving a significant amount of time.
Submitting claims is a necessary requirement in order for your business to receive reimbursement. Whilst submitting claims manually is possible, we would highly recommend utilizing practice management software. These systems automate the process, minimize the risk of errors, and ensure that every single claim is submitted prior to the deadline. Streamlining the claims submission process helps to reduce the likelihood of claim rejections and denials.
Payment posting occurs after a claim has been successfully submitted, and it allows patients to finally pay for the services they received. Features of RCM help to streamline this step and improve patient collection by generating billing statements, automating messages to send to patients, and offering the option for online payments.
We covered quite a bit about how to successfully manage claim denials, and we just want to emphasize here how important it is for you to have specific processes in place to mitigate these occurrences. Focusing on denial management can provide valuable insight into the specific areas that require improvement, leading to increased reimbursement rates and fewer overall denials.
Generating thorough reports that detail your revenue cycle management is a critical component of successfully working through your finances. RCM software will provide your practice with tools that automate these reports and ensure they are as thorough and detailed as possible.
Take home message
Understanding the revenue cycle in healthcare is complicated, and can be both stressful and overwhelming. Nevertheless, it is absolutely essential that you and your employees are familiar with how these processes can be optimized. Revenue cycle management is a great way to minimize the risk of claim denials, whilst boosting the efficiency of your processes and streamlining otherwise time-consuming tasks.