Healthcare Revenue Cycle

Steady cash flow is critical to the success of every business. The healthcare industry, despite its complexity involving clinical procedures and federal regulations, is a thriving business. It is a business model that involves three ‘P’s of healthcare, patient, provider, and payer.

A care process begins with patient admission, it is supervised and administered by providers. Upon the completion of treatment, the payer reimburses the provider for the medical services delivered to a patient. Simple enough, right?

The answer is no! American federal entities that are responsible for the wellbeing and health of its citizens are now focused on improving the quality of healthcare. They also aim to reduce the total costs involved in the process as well.

This has led to healthcare practices navigating a maze of payer rules for reimbursement to reach out to several points of contact. All this, just to obtain a piece of payment for the services they worked so hard to deliver to a patient.

 What is the Role of Healthcare Revenue Cycle Companies?

To successfully navigate the maze of revenue cycle complexities described previously, care providers require the help of a dedicated team of professionals. For any health care service provider healthcare revenue cycle companies are the answer to the billing and claims related conundrums that have been hounding care providers thus far.

With the healthcare industry transitioning towards Value-Based Care (VBC), the onus is on care providers to cope with change in payment models. The burden of meticulous accountability lies on the shoulders of care providers. This ramps up the importance of revenue cycle management exponentially.

Delegating revenue cycle duties to an outsourcing partner gives healthcare providers the room they need to focus on the clinical side of things.

Underpayment Recovery: – Some claims do not receive full payment because of minor niggles in the medical coding process. Health insurance companies clinically dispute a claim and reimburse providers a lesser amount than the one mentioned in the claim. To recover such amounts, a focused effort that requires a comprehensive analysis of complex terms in healthcare contracts. With their dedicated and planned services, healthcare revenue cycle companies make a huge difference to a provider’s operational efficiency with their meticulous approach to RCM.

Denial and Appeals Management: – When it comes to denial management, healthcare revenue cycle companies look for the root cause. They delve into case management and utilization of the services provided to the patient to challenge disputed claims. Their focused effort is the result of many years of experience in managing payment disputes and appeals. Focussing on denial management helps care providers streamline their treatment process to match the insurance terms included in a care plan.

A/R Management: – If accounts receivables is critical to financial management, healthcare revenue cycle companies take great care of A/R by looking after its end-to-end needs. They do this by monitoring all outstanding claims closely. Using an ideal blend of technology and a streamlined follow-up schedule, RCM companies improve the revenue flow of providers.

Coding and Compliance: – The healthcare industry is constantly evolving. New final rules and acts introduce small changes to the terms depicted by medical codes. RMC companies stay updated with these changes and prevent billing errors which would go on to turn into denied claims.

When viewed from a larger context, it can be safely said that healthcare revenue cycle companies approach problems in a care provider’s revenue cycle with a well-defined strategy. This strategy that covers the entire revenue cycle of a hospital helps them operate at maximum financial efficiency.