What is Revenue Cycle Management (RCM)?

What are the goals of revenue cycle management in healthcare?

Successful RCM does more than just help healthcare organizations; it also benefits the patients. Richard Gundling, senior vice president of professional practice for the Healthcare Financial Management Association, says it is important for everyone to be aware of financial expectations.

“It is up to the hospital or doctor to ensure that the resources used for care are properly documented and that if there will be a separate bill, the patient will be notified before the service is completed,” he explains.

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Most patients do not know the details of their health benefits until it is time to use them, and unexpected health expenses can put people in difficult financial situations. An important goal of managing the hospital’s revenue cycle is to inform patients of expenses in advance, allowing them to make financial arrangements, talk to hospital administrators about financial assistance, or seek other treatment if necessary.

“We do not want patients to incur medical debts or be surprised at their expense. The industry is shifting to engaging patients about their financial obligations earlier in the treatment process,” says Gundling.

Accurate and complete collection of information is also important to ensure that claims are not rejected due to lack of information or incorrect coding. Effective RCM mitigates errors and eliminates redundant processes to lower the documentation burden on clinicians and administrative staff.

How does technology improve revenue cycle management in the healthcare sector?

In addition to improving the speed, efficiency, and accuracy of the billing process, technology can improve the patient experience as patients move through their financial journey in healthcare.

“Right from the start, before a patient arrives at the scheduled service, technology can help a patient know the time and place of the appointment,” Gundling says, adding that all patient insurance information should already be collected by the healthcare organization.

Several healthcare organizations are implementing digital-first strategies to improve the efficiency of their RCM instead of relying on phone calls. An automated email or SMS service can remind patients of important appointment information, while apps and online patient intake ensure that insurance information is collected prior to the pre-approval appointment, freeing support staff to work on other tasks.

A suite of software solutions supports revenue cycle management in healthcare, and automation helps speed up the process and reduce errors.

LEARN MORE: Find out how digital-first strategies shape healthcare.

“Much of the pre-approval, which happens at the beginning of the care process to ensure that insurance coverage is available and approved, benefits from automation,” says Gundling. “Automation can help share important insurance benefits, expected diagnoses and related procedure codes and provide price estimates in a more streamlined way.”

RCM programs are usually integrated with a health organization’s electronic health records, where physicians enter patient data and medical codes. But disparate systems can create barriers. Gundling says integration between these systems is the key to streamlining RCM.

Technology is also changing the way patients interact with their insurance providers. Insurance companies will often be able to provide much of the financial information that patients are looking for when engaging in healthcare. There is a shift in this information exchange going from phone calls to secure online chats, sometimes with chatbots, and online price appraisal tools.

Tips for a Successful Revenue Cycle Management Strategy

Gundling emphasizes the importance of transparency throughout the RCM process as well as tools for engaging patients as early as possible in the health journey.

“If patients know what to pay before the service, they are more likely to pay. We want to create a more retail environment to engage the patient early,” he explains. It is not the same in a hospital. “

This principle also applies to emergency room visits. Patients should be treated first, but where appropriate, they should be informed of the costs so that they understand their obligations and can take this information into account when planning additional services or follow-up visits as part of their treatment plans.

Some patients will find insurance language complicated and difficult to understand. Gundling suggests that healthcare organizations engage patients with a mix of people and technology using clear, consumer-friendly language. This makes customer service training an important part of the RCM strategy.

Patients can even ask clinicians billing questions. If clinicians are not able to answer the question themselves, they should be able to point patients in the right direction to find the information they are looking for.

“The patient should feel that there was a good delivery. It’s about people, process and technology, ”says Gundling.

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