Top Healthcare Revenue Cycle Management Challenges

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Top Healthcare Revenue Cycle Management Challenges
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Top Healthcare Revenue Cycle Management Challenges
Revenue cycle management takes care of the
financial flow of healthcare organizations. It
includes managing all those activities which
generate revenue for healthcare organizations
like starting from booking an appointment to
payment of remaining balance and RCM assures
error-free billing process, as well as patients,
develop trust with the organizations that they
are getting the full value of the treatment they
are undergoing. It is necessary to understand
various steps involved in RCM and in the
following brief, you can get an overview of
it. Steps involved in revenue cycle
management Pre-registration and appointment- When
a patient books an appointment, organizations
collect data regarding their demographics,
information related to insurance taken by the
patient and then deduce the eligibility for
treatment as per insurance cover. Insurance
verification- Because insurance companies play a
vital role in revenue generation for a healthcare
organization, so it becomes necessary for them to
verify the cover to avoid any disputes in the
future. Charge capture and claim
submission- After providing needed treatment,
physicians and doctors send all relevant
information regarding the service and treatment
provided to insurance companies for getting paid
for their work.
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Top Healthcare Revenue Cycle Management Challenges
Claim management and Revenue Recovery- Back-end
tasks are performed like posting payments,
managing claim denials, statement processing, and
other follow-ups with insurance
companies. Patient collections- After processing
payments from insurance companies, patients are
meant to pay the balance of the billing. This is
the last step of the revenue cycle as the
balances are paid off by patients. After knowing
about various steps, Why RCM is important for
you hence various RCM advantages are mentioned
below. Advantages of revenue cycle
management Funds in an organization ensure smooth
flow of operations and revenue cycle management
manages those funds generations in healthcare
firms, apart from it offer other benefits
like- Information check- At the stage of
appointment of the patient, revenue cycle
management does the background check related to
insurance taken by the patient, and other related
information of the patient, it ensures that no
piece of data is left unchecked, and all inputs
needed to go ahead with treatment are collected.
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Top Healthcare Revenue Cycle Management Challenges
Determining costs- Revenue cycle management helps
in accurately determining costs of the whole
service including treatment which is to be
provided to the patient and it reduces all
chances of error that might happen in the manual
calculation of such costs. Cash flow
management- It also aids in managing healthcare
organizations present cash flow by estimating
costs acquired while providing treatment, payment
reimbursements from insurance companies, and
settling balances from the patient.Effective cash
flow management is necessary for the
uninterrupted working of the organization and the
steps in the process of revenue cycle assure
that. Ease in collection process- Revenue cycle
management is processing involving steps of
collecting billing payments from insurance
companies and patients, these steps make the
collection process effortless because of the
systematic cycle in place, and therefore it also
helps in avoiding unforeseen uncertainties. Impro
ve patient experience- The objective of a
healthcare organization is to provide continuous
support to patients through their services and
revenue cycle management helps healthcare firms
to provide such an improved experience because
the physicians and doctors are not occupied with
thoughts of payments and reimbursements.
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Top Healthcare Revenue Cycle Management Challenges
However, with all the above advantages healthcare
organizations or physicians are facing various
challenges which should be addressed properly for
revenue optimization and stay afloat in the
practice. Lets understand various
challenges. Challenges uncovered in revenue
cycle management Patient eligibility check- Many
healthcare organizations fail to undergo thorough
research on the eligibility of insurance taken by
the patient which results in problems on the way
of reimbursements of claims submitted to
insurance companies. Strict clearance
process- Healthcare organizations face the
challenge of getting authorization from insurance
agencies for the treatment prescribed to the
patient. They get stuck in their terms and
conditions to comply with which cause a problem
in agreeing for the further claim
process. Reimbursement delays- Because insurance
companies have to comply with their own set of
policies and rules, it becomes a tedious task for
healthcare organizations to get reimbursements on
time, and therefore the whole process of
generating revenue for that service provided gets
delayed.
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Top Healthcare Revenue Cycle Management Challenges
Changing regulations of payer- In the case of
healthcare organizations, insurance companies
constitute the majority of the Payer category and
because of their changing requirements, terms,
and conditions, it becomes difficult for
healthcare firms to comply with them and stay up
to date with their recent changes. Claim denial
management- A sound process is missing with the
cases where claims are denied, there is no proper
information regarding how to move ahead with such
cases and that is the major reason which hurts
patients experience with the healthcare
firm. Hampers productivity to a certain
extent- Physicians and doctors are also well
aware of the fact that changing compliances of
insurance agencies can cause delay or denial in
the claims submitted which in turn hampers their
productivity while providing service to the
patients. Now you have a better understanding of
overall revenue cycle management and its
challenges. However, if you are looking for
outsourcing your medical billing then you can get
in touch with us. We are a team of experienced
billers and coders and have expertise in revenue
cycle management.
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