It is true that there are a lot of tasks associated with running a successful healthcare organization. Effective revenue cycle management is one of the most critical tasks that every provider needs to master if they have to earn the competitive edge. RCM or revenue cycle management is the crux and foundation of the financial circulatory system of a healthcare practice.

Simply put, it encompasses all the clinical and administrative functions that contribute to the capture, collection, and management of patient service revenue. The overarching combination of processing of claims, revenue generation, and payment is what we call healthcare revenue cycle management!

Dig deeper into healthcare Revenue Cycle Management

Healthcare revenue cycle management also involves the use of appropriate technology to track medical claims throughout the entire lifecycle, ensuring that the payments are collected and addressing any denied claims.

· To allow a steady stream of revenue, healthcare providers use effective revenue cycle management tools to complete their medical billing and follow the process with timely identification of any issues that can lead to delayed or canceled payments.

· A transparent system will lead to effective denial management by managing a visible and efficient medical billing process.

· Revenue cycle management will also involve everything from verifying patient’s insurance eligibility, collections of the co-pays with proper coding of the claims as per ICD-10 standards.

Streamlined revenue cycle management is one of the pillars of a healthcare provider’s financial and operational success. A facility’s bottom line is abruptly influenced with inconclusive medical billing efforts, lack of trained staffs that can ensure effective denial management in the best possible manner!

A frictionless revenue cycle management will have to consider these salient areas that are involved with

· Scheduling/ preregistration

· POS registration counseling collections

· Encounter case review and utilization management

· Charge capture and coding

· Claim submissions

· Denial management

· The third party follow up

· Payment posting, appeals as well as collections

It clearly states the fact that revenue cycle is much more than just ensuring the end balance on any account to be zero. It starts right away with the patient making calls for an appointment and ends with all the outstanding payments being collected.

Hence, it is quite evident that laying down the right checks and balances with capturing of insurance information while setting up an appointment is crucial to not waste any time and resources.

· The marketplace has seen some serious advancements and innovations in revenue cycle management in the last few years.

· As it is such an indispensable area of operations, it is no surprise that there will be consequent developments with new software and systems.

· It ranges from direct approaches with software systems as well as indirectly with electronic health records and other technologies associated with healthcare.

· Innovation and improved integration set the tone for operational efficiency.

· Having a single system approach with patient account workflows, registration and scheduling increases productivity and help the users to end tasks without worrying about switching to multiple solution centers.

Managing key areas with system integration, billing and claims management, contact analysis, medical coding, clinical documentation needs implies that healthcare providers look to invest in the latest technology. Only then, it will be possible for them to prepare their revenue cycle for a more realistic value-based care in the truest sense!