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Healthcare RCM: What is it & How can Providers Improve it?

On Oct 31, 2019

Your Healthcare Revenue Cycle Management (Healthcare RCM) involves every step of the billing process starting with the scheduling of the initial appointment and ending with the patient's balance being paid in full. It includes processes like charge capture, claims filing and processing, and the management of difficult collections.

Challenges Associated with RCM:

1) Denials

Perhaps one of the most common challenges associated with Healthcare RCM is a denied claim. Denials can happen for many reasons, the most frequent being an error in coding or the claim being filed too late. Denials lead to a delay in payments, costly claim re-work, or even no payment at all.

2) HDHPs

High Deductible Health Plans (HDHPs) are a trend among patients in recent years that effects your Healthcare RCM. For patients that do not expect to spend much on their medical expenses, HDHPs are great. They enable those patients to save a lot in terms of monthly health costs. The issue with HDHPs is that if a patient encounters unexpected medical services at any time, a much larger portion of the bill falls in their lap. It is much more difficult for a medical provider to get timely payment from the hands of the patient than from an insurance provider.

3) Claims Tracking

A failure to track a filed claim through the complete processing of that claim can lead to a delay in payment. If a claim is rejected or denied during the process, providers have a limited window of time to refile that claim with its correction in hopes that it will be approved the second time. Without the right tools, it can be difficult to track claims effectively which has a large negative impact on your Healthcare RCM.

4) Staffing

Medical billing staff turnaround is a healthcare RCM challenge for many providers. Maintaining a billing staff that is trained properly on current medical billing and coding standards is vital to a successful revenue cycle. Often times, medical billing staff are pulled to other areas of the practice, making it difficult to complete their medical billing duties effectively.

How to Improve Healthcare RCM at Your Practice:

RCM

1) Medical Billing Software

The right medical billing software can make all the difference when it comes to your Healthcare RCM. Quality medical billing software offers providers tools like batch claim filing, enabling them to file multiple claims at one time rather than individually. It also should offer automated claims tracking that notifies providers of a denied claim and gives them simple solutions to resubmit. Medical billing software improves your team's billing workflow, improves your clean claims and reduces staff burnout.

2) Outsource RCM Services

Another solution to your Healthcare RCM challenges is to outsource RCM services at your practice. Many providers are partnering with RCM services vendors to better accomplish their Healthcare RCM goals. Outsourcing your RCM services alleviates your team of their more tedious billing responsibilities and helps them focus on more patient critical tasks. The right vendor of services can help to improve your clean claims drastically by helping you identify and correct possible denial issues before a claim is submitted. Your RCM services vendor can also improve the number of payments by managing your most difficult collections.

3) Online Payment Options

Offering an online payment option is a critical step in increasing the number of patient payments your practice receives and tackling difficulties with HDHPs. Online payment options encourage your patients to make simple payments, 24 hours a day, whenever they are able. Your online payment option should be integrated with your patient portal to help your patients better understand their medical bills and feel comfortable making a payment. An increase in patient payments can have a positive impact on your Healthcare RCM.

4) Practice Management Software

When our medical billing software is integrated fully with your practice management software, providers can greatly improve their Healthcare RCM. Payment plan options featured in your practice management software can offer your patients peace-of-mind through more management solutions. Payment plans help patients feel a sense of control and safety when unexpected medical costs arise. Your practice management software can help you work with your patients to formulate a plan that works best for them.

To learn more about how to improve your Healthcare RCM, click here.

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Kennedy Kylander

By Kennedy Kylander

Kennedy Kylander is a Copywriter based out of Cincinnati, OH with nearly seven years experience in digital marketing. Her passion is helping a business achieve its goals by creating frequent, SEO-driven content that utilizes keyword strategies to increase quality website traffic and sales.
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