The Revenue Cycle Management (RCM) is a crucial process that ensures a simpler billing and collection cycle, reduces denied claims, and improves the healthcare provider’s revenue. With quick and accurate claims processing and minimize claim denials, RCM helps in maintaining the provider’s revenue as well as managing patient billing records.
While efficient RCM is extremely beneficial to any healthcare provider, finding the right people to work on any step of the process can prove to be a challenge. While you may have registered nurses working round the clock to provide quality patient care, are they trained in the revenue cycle process? Are they updated with the latest ICD codes, or understand the RCM process in general?
If not, how can you address this challenge?
Outsourcing provides healthcare providers with the right RCM specialists who are specifically trained and updated with the latest codes, trends, and technology that can process claims faster and more accurately. This gives the business more time to improve revenue and focus on improving the post-treatment patient experience. But which step in the RCM process can you outsource a team?
Take a look at these basic steps of the Revenue Cycle Management process where outsourcing can help:
Acquiring Accurate Patient Information
This the first step for a patient in seeking medical services. Pre-registration basically involves collecting information to create a patient account and includes details such as a person’s medical history and insurance coverages, while during the patient registration stage, concierge specialists schedule the patient’s appointment and get them entered into the system using EMR software. They collect more information that may have been missed out during the pre-registration stage.
How outsourcing helps: An outsourced team of patient service specialists with experience in patient registration and concierge services can accurately collect patient information confidentially and provide excellent patient service through this interaction.
Verifying Insurance and Co-Pay Collection
RCM specialists can also contact the insurance company or logging onto the payer’s website to verify coverage on any payers. This is an important step because it certifies a patient’s insurance in terms of coverage status, active or inactive status, and eligibility status, reducing claim denials and payment delays.
As well, billing specialists collect the total of any deductibles before services are rendered in order to determine eligibility before the patient arrives at the healthcare provider. After verifying all payments from both the patient and the insurance company, the individual will receive their respective treatment.
How outsourcing helps: Outsourced medical billing teams are equipped with the latest software to prepare and submit any billing data to insurance companies and accelerate revenue generation, improve efficiency, and reduce expenses.
Applying Efficient Medical Coding Services
Medical coders convert healthcare diagnoses, procedures, medical services, and equipment into universal medical alphanumeric codes. Coders ensure the codes are correct so that, during the medical billing process, there are minimal to no errors that could slow down claims processing and submission or even denying those claims.
How outsourcing helps: Outsourcing medical coding tasks ensures that your in-house staff can focus on providing patient care. A team of highly-trained coders can analyze diagnoses and translate them into their respective ICD codes accurately.
Streamlining Claims Processing
After the patient receives medical treatment, the healthcare provider submits their respective claims to the insurance company in order to cover any processes and services that the patient will not need to pay. Claims processors provide error-free claims, fixing any issues prior to submission that may increase in denials.
How outsourcing helps: If the first few steps were not accurately done, this translates to several claim denials. It spells revenue loss for the healthcare provider. An outsourced team of highly-skilled and detailed claims processors makes sure that any information collected is correct and accurate and provides faster billing and reimbursement.
In case of denied claims, RCM specialists identify the cause of the denied claim. They check for inaccuracies such as patient information, diagnosis codes, and claims with no authorization or referrals. Once they go through the claim, they assess whether it would require an appeal or if the items or information need to be written off.
Find the right healthcare solutions partner that can build the right RCM team and help you in any or all of these steps—and more—and leave you to focus on what matters most: improving revenue and providing high patient satisfaction.
Infinit-O is a trusted healthcare solutions partner that can help you build and operate a dedicated team of well-trained healthcare & RCM professionals specifically designed for your unique needs, with cost savings of up to 70%. We can help you meet your goals, whether they be growth, better productivity or simply bottom-line cost savings. With access to excellent healthcare talent who use cutting-edge technology, we provide some of the best strategic solutions for your business. We are ISO-certified, HIPAA- and GDPR-compliant, so your company and patient data are safe with us.