10 Steps of Effective Revenue Cycle Management for Healthcare Providers
Valerion Health
August 10, 2023
According to a report by Allied Market Research, the global revenue cycle management market is estimated to reach $329.71 billion by 2030.
Revenue and finance mismanagement can lead to the collapse of healthcare systems, despite providing patients with the right care at the right time. Healthcare organizations around the world are realizing the importance of taking necessary steps to have an efficient revenue cycle management process in place.
Here is a comprehensive checklist of steps to help you effectively manage your revenue cycle.
Contents
- Introduction
- Step 1 – Choose an appropriate revenue cycle management system
- Step 2 – Collect and share accurate information to ensure transparency
- Step 3 – Validate patient information accuracy
- Step 4 – Ensure revenue integrity by leveraging technology
- Step 5 – Submitting accurate codes
- Step 6 – Verification of eligibility and benefits by payers
- Step 7 – Submission of claims to insurance providers
- Step 8 – Remittance processing by insurance providers
- Step 9 – Settlement analysis for receiving correct payment
According to a report by Allied Market Research, the global revenue cycle management market is estimated to reach $329.71 billion by 2030.
Revenue and finance mismanagement can lead to the collapse of healthcare systems, despite providing patients with the right care at the right time. Healthcare organizations around the world are realizing the importance of taking necessary steps to have an efficient revenue cycle management process in place.
Here is a comprehensive checklist of steps to help you effectively manage your revenue cycle.
Step 1 – Choose an appropriate revenue cycle management system
Healthcare organizations must pay attention to factors like service requirements, budgetary constraints and resource availability while choosing a revenue management solution. Irrespective of whether you’re a small-midsized organization or a large healthcare provider, outsourcing operations to a reliable business partner can simultaneously ease your burden, reduce costs and increase operational efficiency.
Step 2 – Collect and share accurate information to ensure transparency
The next crucial step to effectively managing your revenue cycle is proper collection of patient data. Improve transparency by providing your patients estimated treatment costs prior to their treatment. Access to proper and accurate patient information can help you improve customer satisfaction and minimize bad debt. Patients can also estimate out-of-pocket treatment costs and determine payment timelines.
Step 3 – Validate patient information accuracy
It’s important to verify whether the information you have collected is accurate. Every detail from insurance coverage to patient history must be meticulously checked for errors. Once all the details are thoroughly assessed, patients need to sign financial forms. Insurance providers use these forms to assign them coverage benefits. Validating patient information is a necessary step of revenue cycle management as it prevents financial compliance issues.
Step 4 – Ensure revenue integrity by leveraging technology
Your next step is to send billing information to insurance providers. Front desk staff may enter the billing information manually or obtain it digitally to share with the payer.
According to a survey conducted by healthcare technology provider AKASA in 2020, nearly 66% of all healthcare organizations in the US used some form of automation in revenue cycle management. Moreover, nearly 90% of all CFOs of leading hospitals expressed the need for automation solutions in revenue cycle operations.
Leveraging the latest tools can help you effectively maintain revenue integrity by ensuring that you receive the right reimbursement.
Step 5 – Submitting accurate codes
As a healthcare provider that offers several medical services, you use a variety of numeric and alphanumeric ICD codes to describe them. Precise and accurate codes are essential when you’re trying to generate an accurate summary of medical services availed by a patient. Accuracy helps document the right information for diagnoses, procedures and tests which in turn ensures that your patients are billed correctly.
Step 6 – Verification of eligibility and benefits by payers
Insurance providers will check eligibility, verify insurance coverage and assign benefits based on the coded data you provide them. This step of revenue cycle management ensures faster bill payments and minimal errors in the claim settlement process.
Step 7 – Submission of claims to insurance providers
After coding and verification, one of the most important steps in healthcare revenue cycle management is to submit claims to insurance providers. This stage also involves claim scrubbing; to eliminate errors resulting in claim denials or underpayment. Incorrect information in claim documents can result in delayed reimbursements. Efficient revenue management systems can help detect errors and submit claims.
Step 8 – Remittance processing by insurance providers
Upon successful submission and review of claims, insurance providers begin the remittance process. They determine and reimburse the total payable amount. Make sure your insurance provider addresses all concerns regarding delayed payments at this stage. In this step, it is also essential patients are made aware of any overhead expenses for patients.
Step 9 – Settlement analysis for receiving correct payment
In this step, your business assesses services, procedures and pharmaceuticals for which the insurance provider has paid charges. You also assess the reasons behind non-payment of particular items. The most common issues found during this analysis are payment denials and underpayments. After a thorough review, healthcare you’re good to implement necessary measures to receive the correct payment.
Step 10 – Patient collections to avoid bad debt
The final step of the RCM process is collecting payment from patients. A typical process includes e-mailing patients a statement that mentions the amount they need to pay once you’ve received the payment from your insurance provider. Regularly following up with patients helps ensure timely clearance of dues.
Ideally, you should be able to collect payments while your patients are still in your care. Avoid collection backlog and bad debts by introducing a standard policy for managing co-payments and deductibles.
Introducing effective revenue cycle management solutions will allow your team to focus on patient care without the distraction of non-core tasks to perform. Valerion Health acts as an extension of your organization to help create meaningful impact. Get in touch for RCM solutions
Effective revenue cycle management will allow you and your team to focus on delivering value-based patient care without struggling with non-core tasks. At Valerion Health, we are driven to function as an extension of your organization to create meaningful impact. Get in touch for a revenue cycle management system that is tailored to address your organization’s unique challenges and requirements.
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