Revenue cycle management (RCM) refers to the financial process healthcare organizations use to track revenue and bill for patient services to payers. The process begins when a patient makes an appointment and ends with the payer remitting the final payment. RCM is an integral part of successful organizations that includes billing, processing insurance claims, managing complex and challenging denials, and ends with contracted revenue collections from payers.
While RCM can save time and money on accounts receivables, having an efficient RCM strategy can benefit the practice more than just administratively. A good RCM partner can offer much more. With a full suite of products and tools, RCM billing software allows practices to increase revenues proactively, drive efficiency, improve profitability, lower operational cost, and support best practice measures for patient outcomes in health care.
What Can RCM Do For Your Specialty Practice?
Using RCM, a health care organization of any size can gain visibility into key financial and operational data by specialty, practice, and provider. RCM software tracks performance and benchmarks against leading industry metrics. It also works with the data (integrating with electronic health records (EHR)) to give practices the ability to glean real-time insights into key metrics, allowing them to take actionable steps to improve operations and revenue.
Practices can use these real-time insights into key metrics to identify opportunities to increase value in all aspects of the business. Below, we outline some of the benefits RCM can offer your practice:
- Provide Unique Views Of Financial and Clinical Data
An experienced RCM team can significantly streamline your organization’s operations by integrating your financial and clinical records to increase productivity and efficiency in scheduling, resource utilization, data management, credential verification, and appointment reminders. Population health analysis can also be carried out to identify and treat at-risk patients more efficiently. - Maximize Revenue Potential
Hospital expenses have risen more than 23% in less than a decade, putting pressure on industry margins. By effectively managing risk, eligibility, referrals, and authorizations, an RCM management system gives you the ‘bang for your buck’ on any given activity, showing you the balance of quality and cost. Your RCM partner can then recommend steps for you to maximize your revenue collections. - Measure and Improve Performance
RCM can handle contract risk assessments and conduct a documentation gap analysis to help you achieve from where you are to where you want to be, using important metrics such as the total cost of care for drugs and benchmarking against top industry standards. The right RCM partner will help you get insights of value-based care and treatment trends to improve quality of patient care by lowering costs and improved outcomes. - Accelerate Receivables
Overall, RCM reduces time spent in account receivables by managing denials and appeals in a timely manner. Charges are billed out correctly the first time, creating a first pass claim and reducing payment time spent on denials. - Improve Patient Collections
Many clinics struggle to collect patient payments on time. The 2021 Trends in Healthcare Payments Annual Report published by InstaMed tells us that 75% of healthcare organizations still use manual paper methods for collections, even though most patients prefer to pay online.
The same report projects that healthcare can save 48% of the annual spending through automation via RCM. The right RCM provider will offer services that help patients make their contributions, such as up front OOP calculations and online payment plans. In case of bad debt, the RCM partner can work on strategies by partnering with a collections agency. - Leverage Data-Driven Insights To Improve Practice Management
To maximize value in specialty practices (e.g., oncology or urology), consider partnering with an RCM provider with experience in your specialty. The right RCM provider will have subspecialty experience, be data driven and use the right analytical tools to help your practice make decisions based on real-time, with real-world evidence. By analyzing patterns and forecasting trends, RCM can form a key part of a successful development strategy for any practice.
Interested in improving practice performance through revenue cycle management but not sure where to get started?
Check out the replay of our latest RCM webinar where practice leaders discuss why they chose to evaluate an RCM vendor, and tips that every specialty community practice needs to consider as they work to manage their revenue cycle.
Sources:
https://www.hfma.org/topics/news/2022/03/healthcare-news-of-note–staffing-shortages-in-hospitals-and-hea.html
https://mgma.com/resources/resources/revenue-cycle/not-so-graceful-aging-half-of-practices-saw-days-i
https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/Value-Based-Programs
https://www.cms.gov/newsroom/fact-sheets/enhancing-oncology-model
https://revcycleintelligence.com/news/hospital-expenses-have-increased-23-in-less-than-a-decade
https://revcycleintelligence.com/news/patient-collections-takes-over-a-month-for-most-providers
https://www.instamed.com/white-papers/trends-in-healthcare-payments-annual-report/