Healthcare Revenue Cycle Management Services In USA
In this guide, we will talk about Healthcare Revenue Cycle Management Services, their significance, challenges & solutions, and how to streamline your revenue cycle to ensure a healthy medical practice.
So, if your medical practice is spending more time concerning paperwork, you must consider the solutions we’ve mentioned in this detailed guide on Healthcare Revenue Cycle Management services.
Do you want to cut to the chase and get professional assistance to streamline your financial processes and people to boost your Revenue Cycle? You can connect with Panda Infosoft with no second thought!
We are a premier revenue cycle management company in USA, bringing industry expertise blended with technical capabilities. Whether you are an established hospital or thinking about starting a medical practice, we are a one-stop solution for all your Revenue Cycle Management Services needs. Let’s not spend more time here and look at the healthcare RCM services, get insightful understanding, and more.
What Is Revenue Cycle Management?
As the term suggests, Revenue Cycle Management is a financial process that aims to manage the revenue of medical practices. An RCM software typically tracks patient care right from the point of registration, appointment scheduling to the last point of payment.
The process involves a spectrum of operations ranging from curating financial strategy & policy to appointment scheduling, eligibility verification, patient care rendered, documentation, medical coding, charge posting, medical billing, claims submission to denial management, and plenty of other steps in between.
Does it seem complicated to manage on your own? Well, it is complicated, and for this reason, professional RCM companies are here. Would you like to learn more about outsourcing for Revenue Cycle Management Services? We at Panda Infosoft would be happy to assist you. Call us or schedule a discussion online.
Significance Of Using Revenue Cycle Management (RCM)
A small medical practice with good financial health is more effective than recognized hospitals. However, revenue collection is perhaps the most pressing issue in the healthcare industry, complicating survival with increased internal and external pressures.
Moreover, the industry’s legal ramifications and higher regulations often hinder healthcare providers from collecting their patient dues properly. Sometimes outdated bookkeeping technology can also result in reduced revenue. A mix of poor technology and the involvement of various insurance companies screw up the whole process, making it tough to have a healthy cash flow.
In today’s era, ruled by high deductibles and tightening payers regulations, focus on revenue cycle management has become more vital than ever before. An estimate suggests that Healthcare RCM Industry is expected to grow by 12.6% until 2025. If you want to survive in the open competition, sustain the organization and avoid financial losses, you better understand the Revenue Cycle Management Services in detail.
Do you want a deep discussion on Revenue Cycle Management Services and how they strengthen your medical practice? You can connect with RCM professionals at Panda Infosoft. Let’s create a custom RCM strategy to secure your organizational growth. Call us now!
How is the Healthcare Revenue Cycle Is Defined?
The Healthcare Financial Management Association (HFMA) has defined the healthcare revenue cycle management services. It is defined as all administrative and clinical operations that contribute to charge capture, management, and collection of healthcare service revenue.
In the simplest term, this process involves the entire life of a patient account, from registration to final payment posting.
Healthcare Revenue Cycle Flowchart
At Panda Infosoft, we believe in delivering exceptional services. Equipped with cutting-edge technology, we have streamlined our services for end-to-end processes. Our revenue cycle management services are powered by top-notch software and reporting tools.
We understand that successful healthcare revenue cycle management lies in establishing a robust and efficient process. Although medical practices have different workflows, RCM’s main components are the same, and they include;
Patient Scheduling And Registration
We at Panda Infosoft have always been excited to help clients with each segment of the Revenue Cycle Management Services. In the first stage of healthcare revenue cycle management, we simply collect demographic and insurance-related information from patients at the first point, when they schedule an appointment. This process eventually supports the next steps of Revenue Cycle Management Services.
Eligibility Verification And Pre Authorization
It is perhaps the most essential step in Healthcare Revenue Cycle Management Services. Eligibility Verification and Pre Authorization should perform before the services are rendered. It is to ensure that the correct amount is billed and the patient is made aware of the costs that are not covered by their insurance provider.
Patient Visit And Services Rendered
Timely patient outcomes and excellent patient care are both hand in hand in the healthcare industry. These two aspects are essential to ensure that patients are satisfied with the services rendered and treatment. To strengthen these efforts, in 2019, the U.S. government mandated price transparency in healthcare services aimed to reduce consumer dissatisfaction about out-of-pocket costs. It results in happy patients who return for the next time they need care.
Clinical Documentation
Clinical documentation is a vital process that involves documentation of patient visits and services rendered. It contributes to billing and charges entry; thus, this documentation process must be timely, precise, and comply with regulatory standards. EMR software can help practitioners accomplish these goals and streamline the revenue cycle management process by capturing the data that payers might require at the time of claim processing.
Superbill and Charge Entry
RCM efficiency lies in accurate billing, and we at Panda Infosoft have a proven strategy for this. We harness control measures and agile methodologies to ensure diagnosis, procedures, and services are billed appropriately.
Medical Coding & Billing
Nearly 45% of Revenue Cycle Management Services are about medical billing and coding. Therefore, it is highly crucial to execute accurate coding and billing, either by professionals or medical practitioners.
We at Panda Infosoft have CMS-certified EHR and medical coding professionals to code efficiently with ICD-10. As the medical coding system in the USA is complex, we employ certified medical billing professionals to achieve first-time-right claim submission.
We ensure a claim acceptance rate higher than the industry standard with accurate data entry and timely submission.
Claim Submission
We are familiar with the claim process of all leading payers in US healthcare. Besides accurate and timely claim submission, our Revenue Cycle Management Services mainly focus on medical coding because 85% of claims are denied due to wrong coding. Our streamlined approach towards medical coding and claim submission helps boost your practice’s revenue.
Payment Posting
This is the endpoint of Revenue Cycle Management Services, which involves payment posting. Once we receive payment from the payer, based on the patient’s coverage and services billed, we will post the payment.
Denial Management
One of the common reasons for claim denial is Missing or Incorrect Information. Moreover, medical billing and coding errors are the secondary reasons for claim denial. We at Panda Infosoft have experts for denial management, experts in analyzing the claim, finding & rectifying errors, and reclaiming reimbursements.
What Are The Challenges Of Healthcare Revenue Cycle Management?
The healthcare industry in the US is different from the rest of the world. While it seems easy to render healthcare services and collect a payment, the whole process can drain you mentally and physically.
Over 47% of medical practices in the United States claimed that they often struggle to collect payment from patients after their insurance provider refuses to pay. This is not the only challenge that exists in effective revenue cycle management. The healthcare industry is bound to many rules & regulations, which also triggered to complicate the whole process of revenue cycle management services. Here are the significant challenges of healthcare revenue cycle management services.
Ever-Evolving Healthcare Regulations and Reimbursement Models
Over the years, the healthcare industry has witnessed various regulatory changes and complex reimbursements models, which has popped up as one of the biggest challenges for revenue cycle management services.
However, we have developed unique strategies to overcome these challenges. We simply train our employees to perform their tasks in compliance with the latest regulations.
Payment Collection From Patients
With the rise of consumerism and new regulations issued by US healthcare insurance providers, patients are increasingly responsible for paying most of their healthcare costs. However, medical practices need to be proficient in the art of balancing to collect payments from patients without putting in high-pressure sales tactics that may turn the patients to seek care from elsewhere.
Our revenue cycle management services also focus on this concern, and our qualified staff establishes an alternate payment plan to collect the most payment from patients.
Tracking A Claim From Beginning
Practices handling RCM on their own often encounter this challenge as they don’t have enough to track the claim from the beginning, which results in errors, delay in processing, and denial ultimately.
Denial Management
Having a claim denied is frustrating and directly impacts your practice’s bottom line, but you cannot escape this bitter truth. In fact, professional Revenue Cycle Management Services often encounter claim denial. It happens because insurance companies put all their efforts into denying a claim to increase their profit margin.
Each denial increases the unpaid amount of the services rendered. While it directly impacts your revenue, it is essential to have a professional denial management team. At Panda Infosoft, we have the entire Revenue Cycle Management Services on one side and claim denial on the other.
Staff Training
One of the most essential aspects of ensuring efficient revenue cycle management is constantly training your staff in policies, procedures, workflow, and regulations. At Panda Infosoft, we have professionally trained medical billing and coding professionals who sit at the bottom line of every claim processing.
These are some significant challenges of Revenue Cycle Management Services that don’t just hamper cash flow but also reduce revenue. Well, our experts in Panda Infosoft have developed strategies to tackle these challenges and ensure your timely growth.
How To Optimize Revenue Cycle Efficiently?
Do you manage the Revenue Cycle internally? If yes, you are more likely to come across the challenges mentioned above. If you ever wonder how to overcome these challenges without professional assistance, consider optimizing your RCM strategy. Here is how to optimize the Revenue Cycle.
Patient Care
You must focus on delivering exceptional patient care, which ultimately results in high patient outcomes. Also, focus on patient engagement by offering various deals & discounts. It will help to expand your customer base.
Policy
Having strict financial policies and streamlined procedures to address common issues such as unpaid bills helps both staff and patients. In Revenue Cycle Management Services, it is typically managed through pre-registration, payment posting, and clinical documentation, at the earliest.
People
People play the most significant role in building an organization. When running a successful medical practice with healthy finances, it becomes extremely crucial to employ well-trained people, having proficient in their job. At Panda Infosoft, our healthcare revenue cycle management services are offered by such expert people.
With a focus on offering best-in-class revenue cycle management services, we conduct timely training sessions for our employees, educating them about the latest tools and technologies to implement in expanding your medical practice.
Should You Outsource Revenue Cycle Management Services?
Healthcare regulations, reimbursement policies, and technologies have been changing rapidly, making it complicated for healthcare practices to handle on their own without professional assistance. While healthcare providers have to focus on rendering patient care, it would be challenging for them to manage both at once, or shifting focus to RCM from patient care can cost them dearly.
For this reason, healthcare practices are considering outsourcing a better option. A well-thought-out revenue cycle management strategy can mean a significant gap between practices that are struggling to survive and those that are achieving success.
Another reason why healthcare leaders consider outsourcing revenue cycle management services is to reduce overheads and focus on value-based patient care. If you plan to outsource revenue cycle management services, you can expect the following benefits added to your medical practice besides lower expenses and streamlined clinical operations.
Focused Patient Care
Outsourcing revenue cycle management services to a certified and well-experienced provider such as Panda Infosoft help healthcare providers focus on proper patient care without stressing compliance rules.
Staff Management
A reliable Revenue Cycle Management Company will take care of all day-to-day RCM activities like billing, coding, reimbursements, registration, and denial management, reducing overheads from your staff.
Timely Reimbursements
Perhaps this is the reason why you plan to outsource revenue cycle management services, and at Panda Infosoft, we are dedicated to reimbursing the providers for all the services rendered. Our RCM professionals track a claim from the point of start to get efficiency in this.
Reduced Billing Errors
With qualified medical billing professionals by your side, you can expect lower or nearly no billing errors at all. Our staff is trained in the latest technology and billing policies to provide error-free billing to practices, contributing to their reputation.
Need Professional RCM Services? Call Panda Infosoft
Do you want to learn more about outsourcing revenue cycle management services? Connect with our RCM experts at Panda Infosoft. We can assure you of timely reimbursements and accurate payment posting.
Ready to grow your medical practice? Join Panda Infosoft to ensure a smooth journey.