Revenue cycle management has become a keystone in the healthcare industry as the healthcare market is evolving with new regulations, laws, and systems. In healthcare, Revenue cycle management (RCM) is the process that enables organizations to be paid for the provided services. Revenue cycle management has become a basic component to master for all healthcare providers. US healthcare industry is undergoing a significant change due to a new coding system and regulations regarding value-based care. It is mounting pressure on US healthcare providers to enhance patient care and reduce costs. Revenue cycle management is present from registering a patient through the collection. Efficiency and TAT play a vital role in revenue cycle management.
As mentioned, the revenue cycle management (RCM) in healthcare is a multi-stage process, beginning with providers submitting patient documentation to their Revenue cycle management vendors who then code ICD-10 CM according to the patient chat. Then claims are submitted through secured gateways, posted and adjudicated by the insurance. If a claim is paid, the same to be posted to the system. If denied, efforts should be taken to adjust and resubmit the claim before the deadline. Furthermore, if there is a patient responsibility portion following payer adjudication, the patient billing cycle begins.
Revenue cycle management represents a complex business communication with patients, including insurance verification and both point-of-service and after-service collections. Any mismanagement of these functions can lower patient and revenue and damage the reputation of the organization through avoidable denials and bad debts. No matter the size of a practice, hospital or health system, failure to optimally prioritize Revenue cycle management (RCM) and revenue collection efforts can halt growth, increase operational risk and create an uncertain financial future. According to the research conducted by Black Book, 92 percent of hospitals shifted their main focus to revenue cycle management technology and vendor selection over the last year in response to declining healthcare reimbursements.