The Steps That Are Involved in Revenue Cycle Management

by Josh Biggs in Finance on 24th September 2019

The financial aspect of any business is detrimental. It does not matter if you are able to keep your customers satisfied by doing an excellent job. If you don’t take care of your finances, it will be impossible to keep your business afloat. The same goes for medical practice. Your team may be perfect at what they are doing: you need to back the quality healthcare that your team is providing to keep the doors open. The best way to go about it is by paying keen attention to your finances too.

It is for this reason that you need to stay informed on the healthcare revenue cycle, which basically describes the financial process that covers the collection of payment to the management of funds. Here is what the process entails.

  1. Outsourcing Process

The first step is to decide who handles your financial processes. Depending on the size of your medical facility, you have the option of having an IT team in place or hire RCM solutions. Outsourcing this process may be more cost-efficient for you as you can get a dedicated team that has the necessary infrastructure to handle financial operations. This also leaves you with more time and capacity to focus on the patient’s needs.

  1. Pre-authorization

This refers to a restriction that is placed by healthcare insurance on a specific patient’s prescription medication, service, procedure, and equipment. It is the approval of a medical practitioner by a health insurer to provide patients with specific services. Pre-authorization of each patient is done in revenue cycle management.

  1. Eligibility and Benefits Verification

Your clinic has to verify the eligibility of the patients for specific benefits. The front office does this job. To make the process faster, you can use RCM software.

  1. Claims Submission

The fourth step in revenue cycle management is to submit claims for the services you have provided your patient’s with. Submitting claims is essential as it is the only way to get paid for your work.

  1. Posting Payment

Once the claims have been submitted, you are supposed to post the payment so that your patient may pay you. To make the process thorough and convenient, medical clinics use RCM software to send messages to patients to inform them on how much and how they are supposed to make payment.

  1. Denial Management

Denial of claims may result in the downturn of your facility’s revenue. Denial management is an essential process in revenue cycle management as it ensures that you get all the earnings for services rendered out by your facility.

  1. Reporting

Finally, reporting is done to bring to light your financial status and the problems that your facility may be facing. RCM solutions help in generating reports on key performance indicators, financial data, and management information.

Revenue cycle management aims to improve the financial flow at your practice. To make the process more effective and efficient, you need to use RCM software.





Categories: Finance