NWHCBS | Blog

Indicators Physicians Require Revenue Cycle Management

Revenue Cycle Management Services

In the current scenario everything has become process oriented. For any organizations it is important to develop a successful process and policies for staying financially healthy. So why not this process be implemented for physicians?

Health care centres, clinics and larger healthcare systems are known for saving lives and treating patients. Apart from this the healthcare system perceives a constant state of change with regulation changes, restructured payment models, increased or decreased operating costs and much more. With so many variables to deal with, it has become imperative for physicians to implement an effective and efficient process .To effectively manage the impact of these changes, physicians must upgrade to Revenue Cycle Management.

Healthcare revenue cycle management is the financial processes that provide the services for managing the administrative and clinical functions related with the claims processing, payment, and revenue generation. This process helps in incorporating the identification, management, and collection of patient service revenue.

The entire process includes everything, starting from determining the patient eligibility, collecting their co-pay, coding claims correctly, tracking claims, collecting payments and following up on denied claims.

Let’s have a look at few of the factors which indicate if the physician or the healthcare centre requires Revenue Cycle Management for their growth:

Huge volume of self-pay accounts and self-pay after insurance accounts

Finances can make physicians tick! The efficiency of billing processes can have a perilous impact on their financial performance. Self-pay accounts and self-pay-after-insurance accounts can together make up for the tremendous amount of bad debt problems. Revenue management cycle stratagem will ensure maximum patient payment collections and minimize the loss from uncompensated care.

No defined accounts receivable strategy

Reduced cash flow, slow client payments and uncollected debt has a significant effect on the revenue. A well-defined RCM system can help in tracking patient care, which can simplify the billing and collection cycles, by registering, appointing, scheduling and processing the payment.

Long waiting time between the services provided and payment

Mostly, there is a long waiting time between the services provided by the healthcare centre and the payment received, which eventually results in slowing down of the process. RCM can help in reducing the time between offering a service and receiving the payment. This is done by interacting with other health IT systems like electronic health record systems and billing systems.

Considerable quantity of aged high-dollar managed care accounts

More than half of the population these days spends little or nothing on health care, while 5 percent of the population spends almost more than half of the total amount. With the startling evolution in the healthcare industry, that has moved from traditional insurance to managed care, many physician’s find themselves in a position of having a large volume of aged high-dollar managed care accounts. The resulting effect of this is a negative operating margins and a fixed decline in revenue. To protect reimbursements and dodge a large volume of aged high-dollar managed care accounts, physicians must opt for a revenue cycle management strategy. This can help in setting standards for financial stratification to neutralize the piled-up debt.

Healthcare RCM is the number one key in meeting with today’s heath care compliance. The revenue cycle management is continuing to evolve and keep pace with the constant changes in the healthcare ecosystem. Without this key financial process, it can become difficult for the healthcare organizations to keep their doors open to treat patients.