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Why Is Revenue Cycle Management Important in the Healthcare Industry?

what is revenue cycle management in healthcare?

Revenue Cycle Management (RCM) plays an important role in the healthcare industry. Managing revenue is vital for any business but may not be the primary focus of healthcare providers. However, these providers need revenue to pay for medical supplies, salaries, equipment, and more.

Healthcare costs are increasing with technology adoption in a time when an aging population is foreshadowing increased demand for care. Insurance and medical suppliers are placing an increased burden on patients and providers. Value-based healthcare payment models are also reshaping how providers can approach revenue cycle management.

What Is Revenue Cycle in Healthcare?

Revenue Cycle Management is how an organization handles the finances and processes associated with different steps of patient care from start to finish. It begins when a patient is first encountered or scheduled for an appointment and continues through the services provided to the billing afterward. Patient scheduling offers the opportunity to gather information vital to the claims process, such as insurance information, to verify eligibility.

The healthcare revenue cycle process includes coding medical services and billing insurance. Making sure that patients have eligible insurance on file can help in determining costs for various treatments. Faster and more accurate claims transmission allows for greater flexibility in arranging patient care.

After medical services have been provided, another key medical billing RCM process emerges. Managing past due patient accounts and accounts receivables impact the provider’s cash flow through collection times. The revenue cycle in healthcare also includes bad debt or managing uncollectible patient records. When patient accounts are up to date, the cycle continues with scheduling the patient’s next visit and perhaps even offering reminders.

What Is Revenue Cycle Management in Healthcare?

While there are variations between provider types and how the specifics are handled, medical revenue cycle management revolves around the finance and administrative side of the organization.

What is RCM in medical billing? This includes not just patient collection issues but also costs and efficiency of claims submission. These factors are also impacted by staff training.

revenue cycle management process in medical billing

Medical billing has been impacted by recent changes to healthcare models that now focus on value-based care. In addition to this, medical providers have also recently been required to transition to new diagnosis codes ICD10. For more information on understanding the hospital revenue cycle and for assistance with various related issues, consider Nearterm’s Healthcare Revenue Cycle Consulting.

Why Is Revenue Cycle Management Important in the Healthcare Industry?

There are many benefits to efficiently managing your revenue cycle. The overall goal is to increase revenue throughout the various processes by first identifying points of friction and then resolving them.

These problems may include fraud, waste, and abuse such as unnecessary tests and procedures. For some healthcare providers, revenue and finances are not the primary concern. Some may be more focused on patient care.

Problems and issues with an RCM process in healthcare can impact various other processes and take time away from patient care or medical training. The rapid pace of technological improvement has also greatly improved medical billing through electronic data interchange made available by healthcare clearinghouses and electronic claims submission. Technology has improved many other areas but also resulted in new security issues.

Medical revenue cycle management also includes medical records and how they are accessed and stored for billing purposes. Recently there has been an increase in attacks on medical organizations aimed at accessing medical records. These records and other personal health information (PHI) are protected by federal law such as the Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security Rules.

Ensuring medical records are properly protected while processing financial information is a key concern that could potentially detract from patient care. This emphasizes the importance of health information management at your organization. Effective hospital revenue cycle management will include the security of PHI and patient financial information.

Finally, the RCM process in healthcare is important because it can be analyzed to find a process that can be automated safely leading to more time spent with the patient. For more information on why you should outsource your RCM administrative and financial needs contact the healthcare management consultants at Nearterm today!

Revenue Cycle Management Process in Medical Billing

why is revenue cycle management important in the healthcare industry?

The healthcare revenue cycle management process traditionally involved long delays between patient care and associated payment as claims submission was a lengthy process. This is the communication between healthcare providers and the patient’s insurance companies to negotiate payment for services as well as negotiating payment with patients.

What insurance will pay for is impacted by many factors including the patient’s specific plan and what diagnosis codes the provider submits. The medical billing RCM process involves preparing a claim and sending it the insurance. These days technology allows for rapid claim inputting and submission as well as automated “scrubbing” to ensure these claims meet basic requirements for acceptance.

Claims can be rejected for a wide range of problems ranging from a lack of information, improper coding, compatibility issues, and system errors. The number of claims that pass on their first attempt is a key metric to consider in the revenue cycle for medical billing. Multiple claims rejecting for the same errors could be caused by problems with the inputting process as a result of a lack of training. They may be resolved with the proper medical billing denial management process.

Electronic claims can allow for immediate approval for procedures and services from a patient’s insurance company. This can allow a provider to offer a range of services to the patient and increases the likelihood of receiving associated payments. Thus efficiently managing claims allows for greater flexibility in patient care concerning their finances and ability to pay. It also allows the potential for decreasing collection times on services which translates to increased cash flow and better Key Performance Indicator ratios.

On the extreme side of the revenue cycle is the issue of outstanding payments leading to bad debt. Managing the collections process is not always pleasant and will detract from providing valuable care to patients, especially to those in need. Some providers choose to write off the bad debt as a loss.

Efficiently managing RCM, at many different steps in the process, may help to decrease the number of cases that reach bad debt. One powerful solution to these issues is to contract with a third party Healthcare Revenue Cycle Management company. Nearterm’s Healthcare Management Consultants can offer experienced RCM consulting to help increase cash flow, lower bad debt expenses, improve patient satisfaction with financial services, as well as reduce operating costs and increase productivity.

Contact the Nearterm team oday for more information about how our services can make you more productive and profitable.

 

Posted By: nearterm-admin

Clinical Coding Coordinator

JOB ID: EB-1535406314
Location: Florida

The Clinical Coding Coordinator will perform internal quality assessment reviews on HIM Inpatient and Outpatient Coders to ensure compliance with national coding guidelines and coding policies for complete, accurate, and consistent coding that result in appropriate reimbursement and data integrity. Review records with the coding team to improve the accuracy, integrity, and quality of patient data, to ensure minimal variation in coding practices and improve the quality of physician documentation within the body of the medical record to support code assignments. Coordinate with the coding supervisors and manager to also provide coder specific education and global coding education based on review findings and trends.

Requirements:

  • RHIT, RHIA or CCS Certification required
  • 5+ years coding experience required

APPLY NOW

 Please send your resume in Word or PDF format to: [email protected]

Copy and Paste the following job title and EB code and place it in the subject line of your email so we can identify the job: Clinical Coding Coordinator (EB-1535406314)

If you have any questions or would like additional information please call (888) 646-1330

062918

Posted By: nearterm-admin

Senior Revenue Integrity Analyst

JOB ID: EB-1465241181
Location: California

Are you a Senior Revenue Integrity Specialist? Are you interested in working in a fast paced, multi-entity, academic teaching organization? Then keep reading! Our client is looking for a hands-on, energetic individual for their Senior Revenue Integrity Analyst position. They have defined their Revenue Integrity function to include revenue capture, compliance, price modeling, cost analysis and pricing strategy. The successful candidate will have experience maintaining, analyzing, standardizing and modeling revenue charges; providing reference material and charge compliance education; assisting financial planning and analysis; clearing revenue integrity related work queues in EPIC and identifying trends related to the root cause of edits. Review, analyze, verify accuracy of CDM, fee schedules, and associated master files. Perform, document, and communicate annual/interim price adjustments. Assist the Director of Revenue Integrity with driving charge capture and revenue reconciliation to ensure all charges are being captured. Ensure CDM updates occur on a regular basis, synchronize financial systems with CDM maintenance vendor tool monthly, scripts work smoothly, new users are trained, and regular communication with CDM maintenance vendor support with issues and suggestions to continue to enhance the product. Engaging stakeholders throughout the organization; provide guidance, communication and education on correct charge capture, coding and billing processes to clinical department; will oversee the maintenance of the CDM and the payer audit response department; will serve as a key leader in future work flow design and management under EPIC financials; and will approve and /or develop key language for billing agreements between the hospital and physician entities owned by our client. Strong communication and strategic planning skills are key.

Requirements:

  • Bachelor’s degree in Accounting, Finance from an accredited college or university or equivalent experience required.
  • American Association of Healthcare Administrative Management (AAHAM) Certified Revenue Integrity Professional (CRIP) within one year of hire date.
  • Outpatient Coding Certification.
  • Registered Nurse.
  • 5+ years Hospital/Health Care Coding experience
  • Knowledge of various spreadsheet applications.
  • Knowledge of billing requirements related to charges and associated claim forms.
  • Knowledge of cost accounting concepts, principles, and computer applications.

APPLY NOW If you are a highly motivated, proven manager with the experience, skills and knowledge to make a difference for our client……………………

Please send your resume in Word or PDF format to: [email protected]. Copy and Paste the following job title and EB code and place it in the subject line of your email so we can identify the job: Senior Revenue Integrity Analyst (EB-1465241181)

If you have any questions or would like additional information please call (888) 646-1330

062918

Posted By: nearterm-admin

Manager of Denials & Utilization Review

JOB ID: EB-4971828700
Location: CALIFORNIA

Are you well versed in denials and utilization? An expert in healthcare revenue with excellent managerial and interpersonal skills? If so, our client would love an opportunity to talk with you about their Manager of Denials & Utilization Review opening. The successful candidate will have experience in the management of denials and appeals between system and outside payers. Be responsible for concurrent utilization review and management of patients within the system. Serve as a liaison and point of contact for all denial and appeal inquiries. Focus areas include denials and appeals, compilation of management reports such as: 1) denials in progress, 2) wins/partial wins/losses, 3) cases where system has elected not to appeal based on chart documentation/support, and 4) identified cases pending review. Concurrent with these activities, the manager will identify and report on the categorization of denials, suspected or emerging trends related to payer denials and/or slow payment, and lead action planning for correction and process changes to eliminate avoidable denials.

Requirements:

  • Bachelor’s degree in Business, Accounting, Finance, Nursing or related field from an accredited college or university
    Current nursing license in good standing.
  • If not an active California nursing license, would need to become certified in California upon hire. Certification in case management preferred.
  • Must be able to demonstrate an understanding of InterQual and Milliman guidelines, community standards relevant to inpatient acute care, and payer denial and appeal processes.
  • Must be able to exercise independent discretion and judgment, and act at all times with the highest degree of professionalism and objectivity.
  • Must be computer literate and able to manage Outlook, Word and Excel programs, prepare charts and graphs, and analyze data to identify trends and opportunities for process improvement.
  • Knowledge of various spreadsheet applications, including Microsoft Word. Knowledge of billing requirements related to charges.
  • 2+ direct patient care experience as an RN in an acute care setting.
  • 3+ years of experience working with denials and appeals, utilization review, and case management in an acute care setting.
  • 2+ years supervisory experience.

APPLY NOW

Please send your resume in Word or PDF format to: [email protected]
Copy and Paste the following job title and EB code and place it in the subject line of your email so we can identify the job: Manager of Denials & Utilization Review (EB-4971828700)

If you have any questions or would like additional information please call (888) 646-1330

180629

Posted By: nearterm-admin
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