What Is Revenue Cycle Management?
For healthcare providers, revenue cycle management (RCM) defines, collects, and manages a practice or provider’s revenue coming from payers. Revenue cycle management is important in healthcare because it allows practices to remain financially sound and continue providing the highest level of care.
What Is the Goal of Revenue Cycle Management?
The goal of RCM in the healthcare industry is to eliminate operational inefficiencies in the claims and revenue collection processes. Trying to keep up with submitting claims and medical billing processes often results in less attention being given to other critical functions of practice management.
To reach revenue cycle management goals, many providers and practices outsource RCM processes. This helps ensure effective billing and coding that streamlines everything from claims processing to accounts receivable. Partnering with an experienced and certified medical biller is an ideal way to reach your goals of revenue cycle management, improve the patient experience, and shorten turnaround times for patient payments.
What Are the Most Effective Billing and Coding Services Outsourced Providers Offer?
If you’re still asking yourself, “Why is revenue cycle management important in healthcare?” you may be interested in the services that improve the collection and payment processes. Let’s examine some of the most effective billing and coding services available to providers.
Medical Coding
The cornerstone of revenue cycle management in healthcare is detailed and accurate coding. If improper, incomplete, or erroneous coding is submitted, you face denied claims, longer payment processes, and prolonged times in accounts receivable.
In terms of medical coding, the importance of revenue cycle management is to submit error-free and detailed coding. Highly accurate coding minimizes denials and hold-ups while ensuring you’re adequately compensated for your services. AAPC-certified coders account for all CPT codes and modifiers and meticulously apply them to claims. This leads to reduced turnaround times and a more steady cash flow.
Medical Billing
Doctors and nurses should be free to focus on patient care, ongoing training, and expanding their practices. But as you take on new patients and build your practice, it’s easy for medical billing tasks to overwhelm back offices. Rather than dedicating the considerable investments and time required to search for, onboard, train, and compensate new team members, you can take advantage of customized revenue cycle management services.
Credentialing
Before you can begin setting goals for revenue cycle management results and building a robust accounts receivable process, you and your team must be credentialed with insurance carriers. Unfortunately, the credentialing process is complex, time-consuming, and stressful when handled in-house.
The vast amount of data and documentation collection required to become an in-network provider alone is enough to add undue stress to your practice. Add on to that the need to prepare and submit enrollment applications, track and follow up on them, and recredential or revalidate already enrolled providers, and you can see the importance of revenue cycle management services.
Auditing
Even effective billing and coding practices can be improved. You’re likely missing out on revenue if you’re not taking the time to closely examine your medical billing, coding, payment, and claims processes.
Working with an experienced medical billing auditor that stays updated on best practices and regulatory changes helps identify problems in your medical billing processes. Auditing experts tailor solutions to your specific needs and goals of revenue cycle management.
What Benefits Highlight the Importance of Revenue Cycle Management?
Effective billing and coding provide a wealth of advantages to healthcare providers. As with most businesses, money savings is always a goal of revenue cycle management. Outsourcing RCM processes eliminates the costly task of searching for, onboarding, training, and compensating new team members when your operations outgrow your internal capabilities.
Outsourced billing services also play an integral role in increasing revenue. When you submit claims quickly, efficiently, and accurately, patient and payer payments are received in significantly shorter turnaround times. And because the coding used is meticulous, your reimbursement is representative of the services you provided.
Effective billing and coding also mean fewer denials and faster collections. Expedited payments reduce the burden on practice managers, accounts receivable teams, and anyone involved in the payment process. With more time to devote to improving your practice, you help ensure the ultimate patient experience for every person visiting your facility.
