The A-to-Z Guide to Healthcare Revenue Cycle Management

Patient care rarely follows a straight line anymore. Instead of following a predictable sequence of care, patients seek care from multiple providers and sources. In addition, patients often go for second and third opinions, turning the journey into more of a maze than a line. Healthcare providers and payers need to unravel the labyrinth through healthcare revenue cycle management to submit accurate claims and bills.

Learn eight steps to improve your healthcare revenue cycle with more accurate claims for faster payments.

Key Takeaways:

• Healthcare revenue cycle management ensures that providers accurately file claims and reduces the number of denials
• Create a patient-centric revenue cycle that keeps patients involved and informed throughout the billing
• Unifying patient data improves data accuracy and integrity.

What Is Healthcare Revenue Cycle Management?

Healthcare revenue cycle management (RCM) starts with the first interaction with a patient until the final payment and includes all the appointments and care received along the way.

RCM is more comprehensive than regular medical billing revenue cycle as healthcare RCM includes all health-related care, even outpatient care.

The RCM covers a patient’s visit to different services, from specialists to primary care providers. The cycle includes:

• Collecting claims from all patient appointments
• Assigning codes
• Turning those codes into charges
• Collecting the balances

Image Source: Nashville Medical News

How to Efficiently Manage the Healthcare Revenue Cycle

Use these eight steps to manage the healthcare revenue cycle to ensure each patient receives accurate bills and healthcare facilities receive the correct payments.

1. Use Preregistration Processes to Understand Patients

Before the healthcare revenue cycle begins, healthcare workers should preregister patients. Preregistration creates a patient profile with the patient’s health history, demographics, and billing information.

These details are crucial for a successful RCM as they lay the foundation for all future claims. Uploading the information before the cycle begins also reduces how much information employees need to change later in the process.

2. Prioritize the Patient Experience

Patients are becoming increasingly more involved in their care. Patients no longer rely on primary care providers to choose and file claims. Instead, patients seek specialty care and apply for trials independently.

To help engage patients in the revenue cycle management process, providers and payers can also give the patient more control over the filing and processing steps. For instance, a portal with the patient’s information can allow patients to review and confirm details that would impact billing.

Providers should also create a transparent billing process. Pricing transparency helps patients understand what care they will receive and what costs to expect. Therefore, patients can better prepare for the bill, which can result in faster payments.

Image Source: Healthcare Financial Management Association

3. Immediately Create a Claims Submission

The claims submission is the list of code identifiers for the patient’s care and services the healthcare facility provided. The more accurate these codes are, the easier the revenue cycle will run.

To ensure the most accuracy, the care providers should enter the codes as soon as possible after care. Current research shows that 34% of charge denials occurred because of bundling. To avoid overcoding and undercoding, providers should add individual codes to ensure providers don’t miss any services or a patient doesn’t receive a bill for extra services in a bundle. In addition, immediately adding services avoids adding the wrong codes.

4. Automate Claim Coding and Verification

The claim denial rate increased by 23%, so providers are finding innovative ways to improve coding and submission.

Digitizing the healthcare revenue management cycle reduces errors and allows real-time patient data updates. Real-time updates ensure providers don’t double charge for services. Additionally, automating the process improves accuracy.

For example, providers might scan barcodes instead of manually entering codes of medicines to ensure they record the correct code.

5. Preserve Data Integrity

After a provider completes the claim submission for a patient appointment, those claims turn into an invoice with a list of fees. Then, healthcare payers receive the invoice and begin processing the claim. With every new step data enters, there’s a chance that the data’s integrity is compromised.

Using a secure system to upload and share healthcare billing data keeps the data accurate and secure through every step of the healthcare revenue cycle, ensuring correctly processed claims and that patients receive accurate bills.

6. Unify the Patient’s Data

Rarely do healthcare revenue cycles only involve one provider. Many patients see multiple providers for their care and health. When healthcare payers receive numerous submissions from several care providers at once, data can begin overlapping, and errors commonly occur.

To improve your healthcare RCM, unify the claims process. For example, Gaine’s Corperor One Member stores all the patient data in one centralized database for healthcare payers to access. The system collects multiple submissions from multiple companies and then creates a single source of patient information to help payers process and record the patient information correctly the first time.

7. Efficiently Manage Denials

Denials happen in 18% of claims. Revenue cycle management aims to resolve denials quickly and accurately. However, all parties need access to the complete picture to understand claims and denials fully. A patient management system that shows the patient’s journey from start to end can help the provider, payer, and patient understand where the mistake occurred to quickly resolve the denial. 

The payer can then collect accurate payments from the patient without unnecessary delays.

8. Engage Patients to Ensure Complete Payment Collection

Collecting a complete payment for services is what wraps up the revenue cycle. Resolving accounts is often not straightforward. Currently, 17% of US households have medical debt from $195 million of medical payment obligations.

The revenue cycle management process should help ease the financial burden of bills by offering resources to help patients understand and pay them. In addition, connecting patients to assistance programs and payment plans helps healthcare payers receive the payments sooner and reduces the number of patients who can’t make payments. Revenue cycle management systems then track where payments come from, whether from financial aid sources or directly from the patient.

Unify Your Healthcare Revenue Data

Gaine helps healthcare providers and payers record and store customer billing information to process claims faster and more accurately. Healthcare businesses can improve the integrity of their healthcare revenue cycle with our Corperor platform.

Contact us to learn more about our healthcare data management system.