Utilizing revenue cycle management as the top financial process to manage the clinical functions associated with payments and revenue generation in healthcare organizations is very crucial. In other words, revenue cycle management in healthcare is a business process that enables the payment of firms for offering services.
Additionally, the process includes identifying, collecting, and managing patient service revenue. The financial process is vital to making sure that healthcare firms stay in operation to render services to patients. Also, facilities collect profits and afterward keep up with costs using revenue cycle management in healthcare.
One of the factors that enable running a successful medical practice is revenue cycle management. In this article, we discussed revenue cycle management solutions and companies.
What Is Revenue Cycle Management?
Revenue cycle management is a policy that healthcare providers can use to manage the clinical and administrative functions in their revenue cycle. Keep in mind that this revenue cycle starts as soon as a patient reaches out to the healthcare provider to schedule an appointment. This cycle ends when all payments for the appointment and treatment have been gathered. Revenue cycle management aims to identify any resistance in the provider’s revenue cycle in order to resolve it.
What Is Revenue Cycle Management Healthcare?
Revenue cycle management in healthcare is the financial process provisions used to manage the clinical function associated with payment and revenue generation. Furthermore, it refers to the process of identifying, collecting, and managing the constant revenue from patients based on the service rendered. Poor billing practices can amount to financial losses and gradually put at risk the ability to deliver competent care. The revenue cycle in healthcare also includes different insurance companies and government-funded services like Medicare.
Stages of the Revenue Cycle Management in Healthcare
Order, we have three major stages in revenue cycle management in healthcare. They include
- Patient appointment, registration, and treatment.
- Claims submission
- Payment collections
#1. Patient Appointment, Registration, and Treatment.
This is one of the stages of revenue cycle management in healthcare. In this stage, a healthcare facility office will collect resourceful personnel, financial, and insurance information before having an appointment with a patient. In this stage also, registration is carried out to ensure the patients’ details are suitable and accurate from the beginning to the end of the process. During registration, healthcare staff makes sure the correct information about the patient’s address, guarantors, and insurance details is entered.
Online solutions allow medical professionals to monitor appointments, and patients will receive texts, emails, or phone calls to remind them of their visits. Following the registration procedure, the healthcare providers will be able to know if there is a need for specialists, a “green light,” or referrals for treatment. If any of these steps are missing, healthcare tools are not likely to receive payment for their services.
In this stage, the patient’s role is to honor appointments, provide valid information, and discuss their healthcare insurance plans. Furthermore, the healthcare staff’s role is to ensure the patient’s appointment plan is successful.
#2. Claims Submission
This is also one of the stages of the revenue cycle in healthcare, which includes properly coding a patient’s treatment in claims. Claim submission also includes the procedures involved in dealing with a claim denial. Healthcare staff employs specialists that will handle this stage of the cycle because of the complexity of the claim submission.
The experts make this claim on behalf of patients and healthcare equipment. Revenue cycle management makes sure this submission happens quickly by managing and tracking the claim from the start of the process. In this stage also, the patient needs to provide relevant information, and the patient’s treatment has to be properly coded. When this is done, the claim is sent to the insurance company for approval.
#3. Payment Collections
This is the final stage among the stages of revenue cycle management in healthcare. This stage goes with the approval of a submitted plan. Once the insurance company approves the claim, they might not reimburse 100% of a bill to healthcare staff. The insurance company counterchecks the patient’s claim for eligibility, then repays the staff based on the patient’s eligibility.
The patient’s role at this stage of the cycle is to connect the healthcare staff with the insurance staff. Hence, if there is an unpaid bill, the healthcare staff is responsible for reaching out to the patient to collect the remaining payment.
Revenue Management Solutions
What are revenue management solutions?
Revenue management solutions is a tool that is used to track patient purchases and their corresponding payments. Healthcare staff can use revenue management solutions to simply match treatments with payments. Also, accountants can use revenue management solutions to as well simply match purchases with payments. This is all to ensure that revenue is not lost and that the correct department receives the revenue.
Furthermore, the more advanced quality of the revenue management solution enables healthcare managers to track the progress of services rendered by the organization. This is to make medical decisions based on their performance. One can purchase freestanding revenue management solutions, but many solutions come with in-built billing solutions. such as CPQ software and CRM.
Qualities of Revenue Management Solutions
Some of the revenue management solutions include:
- Returning billing.
- CRM and medical integrations.
- Patient portal.
- Multi-currency support.
- Reporting and analytics.
Flows of Healthcare
The flow of healthcare is an important concept to understand the broadness of the healthcare delivery system. It has seven sub-flows in its category. The 7 Flows of Healthcare:
#1. Patients Flow
The most vital strategic priority for healthcare organizations is patient-centered care. Create an environment conducive to treatments and personal needs. You should inform patients of their checkups and treatment plans. They should have ease of access to services and care providers and also get satisfaction in all areas. A calm, mess-free environment, easy change between departments, and patient education and services reduce wait times for procedures and services.
#2. Family Flow
The family visit is often neglected in the flow of discussion. Family visits create a sense of safety and ease. You should allow free access to staff, information, and conveniences for patients’ families. Also consider arranging comfortable seating and sleeping areas, as well as affordable and healthy food options.
#3. Staff Flow
Staff should ensure quality patient care. They should have easy access to their patients and the supplies they need to effectively care for their patients. They should feel helped and communicate effectively with the interdisciplinary team. Going through the rooms, facilities, and departments should make sure that staff invests their time in what’s most important: “quality patient care.”
#4. Medication Flow
Medications can potentially harm patients when proper procedures are not followed. Also, it should be documented, and easily attainable, and patients should be informed about what medicine they are taking. To increase medication safety, there should be strategic locations of medication rooms, supplies, documentation, and the utilization of technologies.
#5. Information Flow
Information should be easily accessible for staff and patients of all ages, languages, and disabilities. Hospital information systems are designed to enable consistency and uniformity in the flow of patient data such as clinical history, orders, lab results, etc. Healthcare facilities should engage in the utilization of technologies for information sharing and coordination of follow-up from home services.
#6. Supplies Flow
Supplies should be easily accessible and at the correct levels. These supplies, such as bandages, gloves, hand sanitizers, detergents, etc. can lead to frustration in patient care if the flow is not managed properly. Hence, we should streamline the management of supplies in healthcare.
#7. Equipment Flow
Equipment should be properly functioning, easily accessible, and instinctively located throughout the space. The equipment flow is often considered less of a priority as it usually involves higher fund allocation. Also, the equipment is used beyond their prescription. Therefore locating systems for equipment is vital.
Revenue Cycle Management Companies
Some of the top revenue cycle management companies to consider if you are looking to make a change from your current revenue cycle services.
#1. ATHELAS
Athelas is one of the revenue cycle management companies. It delivers world-class service, minimizes reimbursement, and delivers actionable ideas into the practice of your financial health. A lot of healthcare practices rely on Athelas for end-to-end revenue cycle service. The key qualities and services of Athelas include;
- Site health metrics – identify where you’re growing and the biggest sources of revenue leakage,
- Providing level ideas -this company also finds which healthcare providers drive the most revenue),
- Benchmarking and projections – Get correct projections and see how you compare them to others.
#2. Athenahealtha
AthenaDX company offers a revenue cycle management solution that helps to reduce the cost to collect. The key qualities and services of Athenahealth include;
- Unified business office – A company that converges hospital and physician group scheduling, billing, and balances into a single system.
- Athena Gamify – Also Game-like experience sits on top of the AthenaDX revenue cycle management system and drives engagement increase from your billing group.
- Athena collector – This cloud-based revenue cycle management solution also delivers leading industry clean claims rates grates to expert services and is continuously updating the billing rules engine.
#3. WAYSTAR
Waystar is one of the revenue cycle management companies too, which provides a single sign-up forum to let you handle payments from the government and private payers all in one place. The key qualities and services of WAY STAR include;
- Financial clearance – Verify insurance benefits.
- Claim management – Also find a faster, clearer path to fuller reimbursement for a better patient experience.
- Revenue capture – This company also involves in Uncovering missing revenue to improve cash flow.
#4. CHANGE HEALTHCARE
The change healthcare company focuses on the efficiency improvement of the staff, optimizing revenue, and upgrading patient engagement. The key qualities and services of change healthcare include;
- Financial discharge – This company has Innovative solutions, eligibility verification, and registration accuracy tools with broad payer connectivity.
- Patient experience tool – Also prioritization of patient care, scheduling, eligibility, cost estimate, payment collection, etc.
- Coverage insight – it also sees tools for charge capture result in distribution, and critical alerts.
#5. eClinicalWorks
ClinicalWorks as one of the revenue cycle management companies give clients a choice of revenue cycle management solution, a personal practice management model. In this case, you manage your own billing. Also, it renders revenue cycle management services, in which eClinicalWorks provides a complete end-to-end solution for your practice.
The key qualities and services of eClinicalWorks include;
- Performance evaluation tool – eClinicalWorks provide a revenue cycle management dashboard and provider analytics.
- Alerts dashboard – eClinicalWorks also prioritize medical claims to avoid missing a payer timely filing window.
- Work lineup dashboards – eClinicalWorks also is an inventory allocation for A/R management.
#6. NextGen
Netgen among the revenue cycle management companies doesn’t have specialized revenue cycle management to help improve financial performance. Also for access to evident billing services, collect operational inefficiencies, and get paid faster.
The key qualities and services of Nextgen include;
- Nextgen charge review rule engine – Nextgen reviews charges for accuracy and scans for errors before a claim is created.
- Clearance house service – Also has In-built intelligence for editing claims.
- Claims intelligent engine – Nextgen also creates automatic formation for editing claims.
#7. Ambulance Revenue Cycle Management(AIM)
Ambulance RCM solution focuses on emergency medical services (EMS). They also provide a single source for easy-to-use, affordable, and configurable dispatch and billing software modules.
The key qualities and services of Ambulance RCM include;
- EMS software – Helps team make reliable and complete documentation.
- Dispatch software – This company also provides logistical software to help with ambulance dispatch.
- Billing solution – Also the goal is to maximize reimbursement for the health system.
#8. National Medical Billing Services
National Medical Billing Services has its focus on Ambulatory Surgery Centers(ASC). Their services include surgery specialization, analytics, and implementation.
The key qualities and services of National Medical Billing Services include:
- Contracting managed care – This company involves in negotiation services for managed care contracts.
- Analytics – Also has business intelligence and analytics(technology solutions) for Ambulatory Surgery Centers.
- Audits – This company also helps with audit preparation and medical coding.
#9. Billing Blues Revenue Cycle Management
Billing Blues company helps hospitals and health systems with end-to-end billing services, including claim processing, collections, billing, and more.
The key qualities and services of Billing Blues RCM include;
- Claim follow-ups – This billing blues RCM company is good at tracking denials and company delays.
- Denials management – Appeals and refiling inclusive.
- Insurance verification – This company also verifies if patients are eligible.
- Certificate issue – this company offers a complete end-to-end certifying process.
#10. Coronis
Coronis Health is good at medical billing and healthcare revenue cycle management. They offer global capabilities and specialized solutions. The key qualities and services of Coronis include;
- Individualize dashboard configuration – the Coronis company has the views of your revenue cycle management performance joined to your needs.
- Specialized services – the company also specializes in primary health, laboratory, behavioral health, and more.
- Performance analysis baseline – the Coronis company also does an investigation on how your practice is doing through one of the experts to help you control costs.
What Are the 10 Steps in the Revenue Cycle?
The ten steps of the revenue cycle management flow include;
- Patient’s appointment, enrollment, and eligibility.
- Documentation, which includes, Patient’s history, orders, prescription, etc.
- Medical coding and charge capture.
- Claims processing.
- Claim level inquiry.
- Remittance counsel.
- Denial and appeal.
- Statements of patients.
- Follow-up patient.
- Follow-up payment and collection
What Are the 6 Stages of the Revenue Cycle in Healthcare?
The revenue cycle management can be broken down into four steps which include;
- Insurance proof.
- Working with your patient and creating your patient’s billing.
- Claims submission and denial management.
- Payment and analysis.
Conclusion
Revenue cycle management’s overall aim of increasing healthcare staff revenue work is to benefit the patients other than anyone else. The revenue cycle management increases staff revenue while decreasing the time spent on management and clinical functions. This implies more money and time to devote to patients and their treatments.
Furthermore, revenue cycle management in healthcare focuses and dedicates all its strength to healthcare facilities to provide the best patient care possible.