Managing and operating a healthcare organization is not something that most doctors like doing more than treating patients. Owners of medical businesses will face even greater difficulties in 2022 due to the decline in the overall workforce, which includes the healthcare industry.
 
According to a recent Mayo Clinic study, the COVID-19 pandemic has increased stress, increased workload, and employee burnout, with one in three doctors intending to cut back on clinical work hours within a year and one in four doctors intending to leave their current practice within the next two years.
 
With increased demands on doctors and dwindling resources, healthcare technology may be an effective supplement to improve revenue cycle management (RCM) and improve the financial performance of medical operations.
 
According to data compiled by the Association of Medical Colleges, the U.S. may have a 37,800–124,000 physician shortfall by 2034 as workload rises as a result of an influx of a “aging population, leading to greater demand for healthcare services.” An easy-to-use solution reduces effort and fatigue by automating RCM processes, allowing doctors to refocus on patient care.
 
What Is RCM?
 
An organization’s internal revenue tracking system is called revenue cycle management (RCM). Generally speaking, this process starts with registration and appointment scheduling and lasts until the final amount payment. It has several phases, including charge collection, claim filing, eligibility verification, rejection handling, and more. Payments may not be reimbursed in a timely manner due to the process’s potential for difficulties and mistakes. Every healthy firm needs a properly managed RCM, and medical billing software is the driving force behind advancement. Reduce bottlenecks at each stage by following these steps:
 
1. Pre-registration, a crucial step in building the patient account that includes personal information like name, contact information, medical history, and insurance coverage, kicks off the RCM procedure. Making sure that this data is gathered and submitted accurately lowers the likelihood of denials brought on by medical mistakes. 40% of patients who saw mistakes in care notes said they thought they were severe, and one in five patients said they did.
 
2. The healthcare provider must record the charge and provide a claims submission once a patient interaction is over. To correctly and automatically convey information to the medical biller/coder, it is crucial to take clear, readable notes.
 
3. The provider must match the treatment’s matching billing code in the claim. To avoid rejections, choosing the proper ICD-10 or CPT code is essential.
 
4. Claims can be filed automatically, in groups, separately, using a superbill, and in other ways. To submit a claim to a clearinghouse like Change Healthcare, a practice often works with an independent biller, a billing business, or an internal billing department.
 
5. Once the claim is lodged, the practice’s obligations continue. The company is still required to manage, keep track of, and collect any reimbursements that insurance does not cover. This involves contacting the patient, processing payment requests, and collecting payments.
 
6. Denial management features should be used by the practice to keep an eye out for denied claims. Claims might be rejected due to incorrect coding, a lack of patient health data, or even incomplete patient accounts. Claims scrubbing programs evaluate them against payer regulations, corporate practice guidelines, and any coding or billing revisions in order to automatically identify and eradicate problems. Practices should be ready to be vigilant with follow-up since claims might travel back and forth between payers and providers for months. This could result in a protracted negotiating process.
 
7. Payment is posted and made available to the patient via an invoice or an online portal following the submission and evaluation of a claim. Remember that patients might not always have the money to pay off any outstanding medical bills right away or in full. If you serve a low-income clientele or patient base, you might want to think about creating a sliding charge plan. To guarantee that you get payment in full for treatments as soon as possible, your practice should be ready to communicate openly with patients at every step of the process.
 
Our revenue cycle management services are modular and may be combined to provide full cycle RCM services or be tailored to your unique process goals. We can take care of certain procedures that require more resources or assume control of the whole RCM. With technology that will have a beneficial effect on your organization, we customize our services around your unique demands and solutions.